MEDICARE: DR. RUBEN RUIZ M.D.

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	174400000X	Specialist	G052245	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912901471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN RUIZ M.D.

Provider Business Mailing Address
First Line	:	833 W WHITTIER BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4735
Country	:	US
Telephone Number	:	323-712-4811
Fax Number	:	323-544-6488

Provider Business Practice Location Address
First Line	:	436 S RIVERSIDE AVE
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376
Country	:	US
Telephone Number	:	909-877-8868
Fax Number	:	909-877-0008

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/16/2019

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