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General NPI Number Information
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NPI Number | 1124545926
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Entity Type | Individual
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Provider Name | MS. MARY JULIA RUTTER
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Gender | Female
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 3440 VIKING DR STE 114
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City | SACRAMENTO
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State | CA
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Zip | 95827-2844
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Country | US
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Telephone | 916-910-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 10383 LARKIN RD SPC 46
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City | LIVE OAK
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State | CA
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Zip | 95953-2128
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Country | US
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Telephone | 530-788-6591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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