Provider Demographics
NPI:1528288719
Name:RUFF, AZUCENA (FNP)
Entity type:Individual
Prefix:
First Name:AZUCENA
Middle Name:
Last Name:RUFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LOCKHEED WAY
Mailing Address - Street 2:BLDG 601 / MEDICAL / ROOM 119/ MAIL DROP 0199
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93599-0199
Mailing Address - Country:US
Mailing Address - Phone:661-572-2191
Mailing Address - Fax:661-572-2150
Practice Address - Street 1:1011 LOCKHEED WAY
Practice Address - Street 2:BLDG 601 / MEDICAL / ROOM 119/
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93599-0199
Practice Address - Country:US
Practice Address - Phone:661-572-2191
Practice Address - Fax:661-572-2150
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN703157163W00000X
CANP17235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ097ZMedicare PIN
CABI945ZMedicare PIN
CABJ097YMedicare PIN