Provider Demographics
NPI:1043972870
Name:RUIZ, TIFFANIE CAMILLE (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:CAMILLE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W EULALIA ST STE 211
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2851
Mailing Address - Country:US
Mailing Address - Phone:818-502-4567
Mailing Address - Fax:818-502-4568
Practice Address - Street 1:222 W EULALIA ST STE 211
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2851
Practice Address - Country:US
Practice Address - Phone:818-502-4567
Practice Address - Fax:818-502-4568
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily