MEDICARE: MONIQUE RUFFIN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	174H00000X	Health Educator
3	171M00000X	Case Manager/Care Coordinator
4	172A00000X	Driver

General Provider Information

NPI Number	:	1194055806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE RUFFIN

Provider Business Mailing Address
First Line	:	6904 BRIER CREEK LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6904 BRIER CREEK LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4321
Country	:	US
Telephone Number	:	253-302-6411
Fax Number	:

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

Provider Enumeration Date	:	12/30/2009
Last Update Date	:	01/07/2010

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Directions to “ MONIQUE RUFFIN ” Practice Location

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