MEDICARE: JESSICA RUIZ

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	2355A2700X	Audiology Assistant	SLPA8844	AZ
2	2355S0801X	Speech-Language Assistant	SLPA8844	AZ

General Provider Information

NPI Number	:	1619384245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RUIZ

Provider Business Mailing Address
First Line	:	534 W ROMA AVE APT 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2996
Country	:	US
Telephone Number	:	602-647-3277
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 W ROMA AVE APT 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2996
Country	:	US
Telephone Number	:	602-647-3277
Fax Number	:

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	02/09/2024

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Directions to “ JESSICA RUIZ ” Practice Location

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