Healthcare Provider Details

I. General information

NPI: 1730056565
Provider Name (Legal Business Name): JESSE RUVALCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N BLACKSTONE ST
TULARE CA
93274-4449
US

IV. Provider business mailing address

426 N BLACKSTONE ST
TULARE CA
93274-4449
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2021
  • Fax:
Mailing address:
  • Phone: 559-687-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberB80BDD16F0
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: