Healthcare Provider Details

I. General information

NPI: 1073478640
Provider Name (Legal Business Name): CINTHIA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 E GREENWAY ST
MESA AZ
85203-4532
US

IV. Provider business mailing address

1745 E GREENWAY ST
MESA AZ
85203-4532
US

V. Phone/Fax

Practice location:
  • Phone: 480-524-7351
  • Fax:
Mailing address:
  • Phone: 480-524-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number54084142
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: