Provider Demographics
NPI:1386199370
Name:RUPPERT, BEVERLY SALAZAR
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SALAZAR
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODLAND RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9501
Mailing Address - Country:US
Mailing Address - Phone:707-968-0670
Mailing Address - Fax:707-968-9580
Practice Address - Street 1:6 WOODLAND RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9501
Practice Address - Country:US
Practice Address - Phone:707-968-0670
Practice Address - Fax:707-968-9580
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53890363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical