MEDICARE: ELISE MEE LING RUIZ-HOM

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1538601067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE MEE LING RUIZ-HOM

Provider Business Mailing Address
First Line	:	11700 SW BUTNER RD APT 206
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5758
Country	:	US
Telephone Number	:	808-227-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 SW BUTNER RD APT 206
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5758
Country	:	US
Telephone Number	:	808-227-3488
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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