1417680638 NPI number — DANIELLE RUCCI PHYSICIAN ASSISTANT

Table of content: DANIELLE RUCCI PHYSICIAN ASSISTANT (NPI 1417680638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417680638 NPI number — DANIELLE RUCCI PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUCCI
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUCCI
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417680638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 POPLAR BLVD UNIT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91803-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 ARDEN AVE STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-247-6676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2022

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: 363A00000X , with the licence number:  62896 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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