MEDICARE: NG IRENE H RUIDERA NP

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	363L00000X	Nurse Practitioner	NP13451	CA

General Provider Information

NPI Number	:	1750458527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NG IRENE H RUIDERA NP

Provider Business Mailing Address
First Line	:	1526 N EDGEMONT ST
Second Line	:	3RD FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5260
Country	:	US
Telephone Number	:	323-783-4595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 N EDGEMONT ST
Second Line	:	3RD FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5260
Country	:	US
Telephone Number	:	323-783-4595
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/03/2021

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