Provider Demographics
NPI:1497738678
Name:OSAH, RUBY MENDEZ (CRNA)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:MENDEZ
Last Name:OSAH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 HASTI JOY CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4816
Mailing Address - Country:US
Mailing Address - Phone:661-432-8962
Mailing Address - Fax:
Practice Address - Street 1:1100 MAGELLAN DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-823-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526174367500000X
CA4097367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497738678Medicaid
TX88925UOtherBCBS
TX8K9915Medicare PIN
CA1497738678Medicaid