Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 95011014 | CA |
NPI | 1174994107 |
---|---|
Provider Name | Jasmine Ruiz |
First Address | East Palo Alto, CA 94303-1312 |
Second Address | East Palo Alto, CA 94303-1312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2015 |
Last Update Date | 13/05/2019 |