Healthcare Provider Details

I. General information

NPI: 1649104829
Provider Name (Legal Business Name): RUTH EVIDELIA CORTES CARVAJAL DNP, FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 BLACKSTONE DR
WALNUT CREEK CA
94598-3722
US

IV. Provider business mailing address

2239 BLACKSTONE DR
WALNUT CREEK CA
94598-3722
US

V. Phone/Fax

Practice location:
  • Phone: 210-872-4724
  • Fax:
Mailing address:
  • Phone: 210-872-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11009079
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95019463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: