Provider Demographics
NPI:1821142555
Name:RUIZ BOTELLO, BLANCA ESTHER (NP)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:ESTHER
Last Name:RUIZ BOTELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:ESTHER
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5 CENTERPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1050
Practice Address - Country:US
Practice Address - Phone:714-562-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585343363LF0000X
CA14969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily