Healthcare Provider Details

I. General information

NPI: 1407054414
Provider Name (Legal Business Name): RUTH M BOISSEREE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POSADA LANE SUITE 202
TEMPLETON CA
93465-4060
US

IV. Provider business mailing address

117 WEST BUNNY AVENUE
SANTA MARIA CA
93458-2805
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5497
  • Fax: 805-434-0917
Mailing address:
  • Phone: 805-739-3474
  • Fax: 805-739-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number17321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: