Provider Demographics
NPI:1558420919
Name:TESFAYE, RUTH (FNP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E CLAIBORNE DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2455
Mailing Address - Country:US
Mailing Address - Phone:562-716-9202
Mailing Address - Fax:
Practice Address - Street 1:4101 TO TORRANCE AVE MEDICAL STAFF
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-303-5238
Practice Address - Fax:310-303-5619
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily