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General NPI Number Information
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NPI Number | 1831273002
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Entity Type | Organization
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Legal Business Name | NIRUYISPC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/08/2011
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Provider Practice Location Address
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Address Line | 3037 MARTHA DR
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City | VENTURA
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State | CA
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Zip | 93003-2934
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Country | US
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Telephone | 805-656-6911
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Fax | 805-643-2671
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Provider Business Mailing Address
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Address Line | 3037 MARTHA DR
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City | VENTURA
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State | CA
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Zip | 93003-2934
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Country | US
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Telephone | 805-656-6911
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Fax | 805-643-2671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAM NIRUYI
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Credential | DDS
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Telephone | 602-320-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5292
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 56796
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License Number State | CA
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