Healthcare Provider Details

I. General information

NPI: 1073658696
Provider Name (Legal Business Name): CLAUDIA R RUIZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NORTH IMPERIAL AVENUE SUITE 1
EL CENTRO CA
92243
US

IV. Provider business mailing address

516 WEST ATEN ROAD SUITE 2
IMPERIAL CA
92251
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-4710
  • Fax: 760-353-6015
Mailing address:
  • Phone: 760-355-7730
  • Fax: 760-355-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: