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General NPI Number Information
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NPI Number | 1598569105
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Entity Type | Individual
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Provider Name | JASSON EMMANUEL RUIZ
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2055 N PERRIS BLVD STE C
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City | PERRIS
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State | CA
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Zip | 92571-2509
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Country | US
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Telephone | 519-715-5050
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Fax | 951-715-5050
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Provider Business Mailing Address
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Address Line | 28806 MALTBY AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-6919
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Country | US
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Telephone | 213-374-4996
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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