Healthcare Provider Details

I. General information

NPI: 1407514169
Provider Name (Legal Business Name): CARMEN RUIZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST STE 100A
GLENDALE CA
91204-2850
US

IV. Provider business mailing address

7439 LA PALMA AVE STE 120
BUENA PARK CA
90620-2655
US

V. Phone/Fax

Practice location:
  • Phone: 818-277-0567
  • Fax: 818-244-5122
Mailing address:
  • Phone: 714-522-2001
  • Fax: 714-522-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARMEN RUIZ
Title or Position: OWNER
Credential: M.D.
Phone: 918-605-8140