Provider Demographics
NPI:1588878177
Name:ROSENBLUM, RUTH KOPPEL (RN, NP)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:KOPPEL
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 ESTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1325
Mailing Address - Country:US
Mailing Address - Phone:408-267-0174
Mailing Address - Fax:
Practice Address - Street 1:1521 ESTELLE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1325
Practice Address - Country:US
Practice Address - Phone:408-267-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 449701363LP0200X
CANP 8679363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics