Basic Information
| Provider Information | |||||||||
| NPI: | 1497738678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSAH | ||||||||
| FirstName: | RUBY | ||||||||
| MiddleName: | MENDEZ | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4708 HASTI JOY CT | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933094816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614328962 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 MAGELLAN DR | ||||||||
| Address2: | |||||||||
| City: | TEHACHAPI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618233000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 526174 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 4097 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1497738678 | 05 | CA | MEDICAID | 88925U | 01 | TX | BCBS | OTHER |