Healthcare Provider Details

I. General information

NPI: 1992649263
Provider Name (Legal Business Name): RUTH ELISA ZELEDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CAMPBELL AVE
VALLEJO CA
94590-7104
US

IV. Provider business mailing address

11 NICHOLL AVE
RICHMOND CA
94801-3918
US

V. Phone/Fax

Practice location:
  • Phone: 510-260-7992
  • Fax:
Mailing address:
  • Phone: 510-837-0364
  • Fax: 510-837-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License NumberD1228801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: