Healthcare Provider Details

I. General information

NPI: 1518707793
Provider Name (Legal Business Name): RUBY RUANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON BLVD STE B180
WEST SACRAMENTO CA
95605-2394
US

IV. Provider business mailing address

3509 JEFFREY PINE LN
ROCKLIN CA
95677-4076
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95065334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: