Basic Information
| Provider Information | |||||||||
| NPI: | 1770986226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUFFY | ||||||||
| FirstName: | MARICEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2348 CAROL ANN DR | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953776615 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 955 W CENTER ST | ||||||||
| Address2: | SUITE 12 A | ||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953377300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092399600 | ||||||||
| FaxNumber: | 2092392244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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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 | 164X00000X | 247305 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.