Provider Demographics
NPI:1568704641
Name:MONDOLFI, RUTH NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:NICOLE
Last Name:MONDOLFI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ORONOCO ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2237
Mailing Address - Country:US
Mailing Address - Phone:303-885-9670
Mailing Address - Fax:
Practice Address - Street 1:16035 CAPUTO DR STE B
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5528
Practice Address - Country:US
Practice Address - Phone:303-885-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17402084P0800X
CA20A156252084P0800X
AZ0073322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry