Provider Demographics
NPI:1366717498
Name:RUIZ, NIMFA ANCHETA (RN)
Entity type:Individual
Prefix:MRS
First Name:NIMFA
Middle Name:ANCHETA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 FOOTHILL BLVD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9384
Mailing Address - Country:US
Mailing Address - Phone:909-899-3920
Mailing Address - Fax:909-899-3926
Practice Address - Street 1:12730 FOOTHILL BLVD
Practice Address - Street 2:UNIT 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9384
Practice Address - Country:US
Practice Address - Phone:909-899-3920
Practice Address - Fax:909-899-3926
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477377171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator