Provider Demographics
NPI:1578334215
Name:RIPPL CARE PC OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:RIPPL CARE PC OF CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN REKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-338-9279
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0352
Mailing Address - Country:US
Mailing Address - Phone:206-647-1007
Mailing Address - Fax:
Practice Address - Street 1:901 W CIVIC CENTER DR FL 2
Practice Address - Street 2:OFFICE 4029
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2352
Practice Address - Country:US
Practice Address - Phone:206-647-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health