Healthcare Provider Details

I. General information

NPI: 1720766090
Provider Name (Legal Business Name): MIGUEL ANGEL RUIZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 FLORENCE AVE
BELL GARDENS CA
90201-4732
US

IV. Provider business mailing address

1032 JANETTE ST
HACIENDA HEIGHTS CA
91745-1207
US

V. Phone/Fax

Practice location:
  • Phone: 213-556-1746
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: