Provider Demographics
NPI:1306363791
Name:RUIZ, JEANETTE MARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4661
Mailing Address - Country:US
Mailing Address - Phone:833-413-9745
Mailing Address - Fax:
Practice Address - Street 1:6201 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:EAST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4661
Practice Address - Country:US
Practice Address - Phone:833-413-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA793803163WP2201X
NYF343540-1363LF0000X
CA95009357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care