1821612243 NPI number — DRUSILLA EUPHRATES AANIQUE RUFFIN

Table of content: DRUSILLA EUPHRATES AANIQUE RUFFIN (NPI 1821612243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821612243 NPI number — DRUSILLA EUPHRATES AANIQUE RUFFIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUFFIN
Provider First Name:
DRUSILLA
Provider Middle Name:
EUPHRATES AANIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821612243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21600 OXNARD ST STE 1800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91367-7807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-345-2345
Provider Business Mailing Address Fax Number:
--

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14059 CROWN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22193-1458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-368-6876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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