Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 20053 | CA |
NPI | 1285773044 |
---|---|
Provider Name | Mrs. Sally Anne Ruger |
First Address | Rancho Santa Margarita, CA 92688-3521 |
Second Address | Irvine, CA 92604-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |