Healthcare Provider Details

I. General information

NPI: 1578334215
Provider Name (Legal Business Name): RIPPL CARE PC OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W CIVIC CENTER DR FL 2 OFFICE 4029
SANTA ANA CA
92703-2352
US

IV. Provider business mailing address

PO BOX 352
MERCER ISLAND WA
98040-0352
US

V. Phone/Fax

Practice location:
  • Phone: 206-647-1007
  • Fax:
Mailing address:
  • Phone: 206-647-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON VAN REKEN
Title or Position: MANAGER
Credential:
Phone: 775-338-9279