Provider Demographics
NPI:1235233743
Name:VANDERPLAS, RUTH ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ELLEN
Last Name:VANDERPLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47647 CALEO BAY DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8854
Mailing Address - Country:US
Mailing Address - Phone:760-777-7993
Mailing Address - Fax:760-777-4244
Practice Address - Street 1:47647 CALEO BAY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8854
Practice Address - Country:US
Practice Address - Phone:760-777-7993
Practice Address - Fax:760-777-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88507207N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A885070OtherBLUE SHIELD PIN
CAZZZ05380ZMedicare PIN
CA00A885070OtherBLUE SHIELD PIN