Provider Demographics
NPI:1770986226
Name:RUFFY, MARICEL
Entity type:Individual
Prefix:MISS
First Name:MARICEL
Middle Name:
Last Name:RUFFY
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 1:2348 CAROL ANN DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-6615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:955 W CENTER ST
Practice Address - Street 2:SUITE 12 A
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7300
Practice Address - Country:US
Practice Address - Phone:209-239-9600
Practice Address - Fax:209-239-2244
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247305164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse