Provider Demographics
NPI:1144260118
Name:CHAMBI - HERNANDEZ, RUTH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CHAMBI - HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16954 CRAMER CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-6278
Mailing Address - Country:US
Mailing Address - Phone:951-531-7242
Mailing Address - Fax:
Practice Address - Street 1:1871 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2601
Practice Address - Country:US
Practice Address - Phone:909-297-3337
Practice Address - Fax:909-532-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A874530Medicaid
CA00A874530Medicare ID - Type UnspecifiedNORTHERN CALIFORNIA
CA00A874530Medicaid
CAH93095Medicare UPIN