Provider Demographics
NPI:1972027506
Name:RUH, JANELLE ALYCE
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ALYCE
Last Name:RUH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33716 SURFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2152
Mailing Address - Country:US
Mailing Address - Phone:949-306-8477
Mailing Address - Fax:
Practice Address - Street 1:510 MARIGOLD AVE
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2407
Practice Address - Country:US
Practice Address - Phone:949-610-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243342164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse