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General NPI Number Information
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NPI Number | 1346372026
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Entity Type | Individual
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Provider Name | MARY E RUPPERT D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 2521 MICHELLE DR
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City | TUSTIN
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State | CA
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Zip | 92780-7014
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Country | US
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Telephone | 888-988-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GRAY STONE WAY
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-9330
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Country | US
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Telephone | 949-233-8447
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A5541
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License Number State | CA
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