Provider Demographics
NPI:1598198897
Name:RUVALCABA, JOSE DEJESUS (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DEJESUS
Last Name:RUVALCABA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:DEJESUS
Other - Last Name:LIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:813 E FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4003
Mailing Address - Country:US
Mailing Address - Phone:562-665-4638
Mailing Address - Fax:
Practice Address - Street 1:813 E FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-4003
Practice Address - Country:US
Practice Address - Phone:562-665-4638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant