MEDICARE: SOPHIA RUEF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA.0008331	CO
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1033982814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA RUEF

Provider Business Mailing Address
First Line	:	465 MAR VISTA DR
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3723
Country	:	US
Telephone Number	:	805-748-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 MAR VISTA DR
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3723
Country	:	US
Telephone Number	:	805-748-0198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	01/11/2024

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Directions to “ SOPHIA RUEF ” Practice Location

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