Healthcare Provider Details

I. General information

NPI: 1083522049
Provider Name (Legal Business Name): CARLOS IGNACIO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 LAS VIRGENES RD
CALABASAS CA
91302-1929
US

IV. Provider business mailing address

15026 1/2 POLK ST
SYLMAR CA
91342-5014
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-4000
  • Fax:
Mailing address:
  • Phone: 818-876-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: