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NPI Code Detail

MEDICARE: GABRIEL RUIZ R.D.A

MEDICARE: GABRIEL RUIZ R.D.A
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
1126800000XDental Assistant82313CA

General Provider Information

NPI Number : 1568810042
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL RUIZ R.D.A
Provider Business Mailing Address
First Line : 12121 WILSHIRE BLVD STE 1111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-1188
Country : US
Telephone Number : 310-409-4265
Fax Number : 310-820-0588
Provider Business Practice Location Address
First Line : 12121 WILSHIRE BLVD STE 1111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-1188
Country : US
Telephone Number : 310-409-4265
Fax Number : 310-820-0588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2016
Last Update Date : 05/25/2016

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