MEDICARE: MRS. RUTH A ABOIRALOR

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	363LF0000X	Family Nurse Practitioner	95005573	CA

General Provider Information

NPI Number	:	1417468158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH A ABOIRALOR

Provider Business Mailing Address
First Line	:	13508 PURCHE AVE
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90249-2331
Country	:	US
Telephone Number	:	310-483-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2734
Country	:	US
Telephone Number	:	310-483-8411
Fax Number	:

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

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	10/20/2017

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