MEDICARE: RUTH GRACE WANJIRU PA

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	363A00000X	Physician Assistant	11366	AZ

General Provider Information

NPI Number	:	1871309583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GRACE WANJIRU PA

Provider Business Mailing Address
First Line	:	3530 S VAL VISTA DR # C101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7318
Country	:	US
Telephone Number	:	480-840-9155
Fax Number	:	480-840-9320

Provider Business Practice Location Address
First Line	:	3530 S VAL VISTA DR # C101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7318
Country	:	US
Telephone Number	:	480-840-9155
Fax Number	:	480-840-9320

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	02/13/2026

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