MEDICARE: HUMBERTO RUIZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47168	CA

General Provider Information

NPI Number	:	1023147865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMBERTO RUIZ D.D.S.

Provider Business Mailing Address
First Line	:	1839 PINNACLE WAY
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784
Country	:	US
Telephone Number	:	951-833-7345
Fax Number	:	626-337-3573

Provider Business Practice Location Address
First Line	:	4157 MAINE AVE
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-3309
Country	:	US
Telephone Number	:	626-337-1506
Fax Number	:	626-337-3573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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