Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A80193 | CA |
NPI | 1376725630 |
---|---|
Provider Name | Mauro B Ruffy |
First Address | San Jose, CA 95124-4107 |
Second Address | San Jose, CA 95124-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 04/12/2020 |