Healthcare Provider Details

I. General information

NPI: 1689583023
Provider Name (Legal Business Name): EMILIANO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 BLACK BEAR ROAD
JUNEAU AK
99801
US

IV. Provider business mailing address

19324 RANDALL RD
JUNEAU AK
99801-8208
US

V. Phone/Fax

Practice location:
  • Phone: 907-957-0647
  • Fax: 907-789-8443
Mailing address:
  • Phone: 907-957-0647
  • Fax: 907-789-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: