MEDICARE: JASSON EMMANUEL RUIZ

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	225400000X	Rehabilitation Practitioner
2	175T00000X	Peer Specialist	MPSS-DLJIEZ	CA
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1598569105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASSON EMMANUEL RUIZ

Provider Business Mailing Address
First Line	:	28806 MALTBY AVE
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-6919
Country	:	US
Telephone Number	:	213-374-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 N PERRIS BLVD STE C
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-2509
Country	:	US
Telephone Number	:	519-715-5050
Fax Number	:	951-715-5050

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	03/09/2026

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Directions to “ JASSON EMMANUEL RUIZ ” Practice Location

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