Healthcare Provider Details

I. General information

NPI: 1194895110
Provider Name (Legal Business Name): RUTH DIGNADICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST BLDG 50
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

24171 PALMEK CIR
LAKE FOREST CA
92630-5221
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8665
  • Fax:
Mailing address:
  • Phone: 949-587-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number526439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: