Provider Demographics
NPI:1104915727
Name:RUHE, SHARLYN R (PA-C)
Entity type:Individual
Prefix:
First Name:SHARLYN
Middle Name:R
Last Name:RUHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHARLYN
Other - Middle Name:D
Other - Last Name:RAVAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2907 SHELTER ISLAND DR
Mailing Address - Street 2:STE 105, PMB 239
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2743
Mailing Address - Country:US
Mailing Address - Phone:210-287-8084
Mailing Address - Fax:619-546-6415
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:128
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-2771
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q77130Medicare UPIN