Healthcare Provider Details

I. General information

NPI: 1255907846
Provider Name (Legal Business Name): JANEVI JUNE RUIZ REBERNIGG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

543 TAYLOR AVE
COLUMBUS OH
43203-1278
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-3333
  • Fax:
Mailing address:
  • Phone: 614-685-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberOS23459
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.033891
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: