Healthcare Provider Details

I. General information

NPI: 1679289839
Provider Name (Legal Business Name): ALFREDO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5663 W KING SNAKE DR
TUCSON AZ
85742-8335
US

IV. Provider business mailing address

5663 W KING SNAKE DR
TUCSON AZ
85742-8335
US

V. Phone/Fax

Practice location:
  • Phone: 928-247-5795
  • Fax:
Mailing address:
  • Phone: 928-247-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number218233
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: