Healthcare Provider Details

I. General information

NPI: 1417336934
Provider Name (Legal Business Name): ERICK RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E. HUNTINGTON DR
DUARTE CA
91010-2221
US

IV. Provider business mailing address

2502 E. HUNTINGTON DR
DUARTE CA
91010-2221
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-1514
  • Fax: 626-288-8903
Mailing address:
  • Phone: 626-357-1514
  • Fax: 626-288-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: