Healthcare Provider Details

I. General information

NPI: 1609484997
Provider Name (Legal Business Name): DR. MELISSA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 W PEORIA AVE STE 101
PHOENIX AZ
85029-5213
US

IV. Provider business mailing address

PO BOX 566283
MIAMI FL
33256-6283
US

V. Phone/Fax

Practice location:
  • Phone: 928-482-3614
  • Fax:
Mailing address:
  • Phone: 305-798-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012338
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: