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General NPI Number Information
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NPI Number | 1700459161
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Entity Type | Individual
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Provider Name | HILDEBERTO RUIZ-JARQUIN
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Gender | Male
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1290 COMMODORE DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-2304
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Country | US
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Telephone | 650-583-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 170 S SPRUCE AVE FL 2
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-4557
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Country | US
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Telephone | 415-933-0829
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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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 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 #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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