Healthcare Provider Details

I. General information

NPI: 1225433162
Provider Name (Legal Business Name): EYDIE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W LACEY BLVD STE 1
HANFORD CA
93230-4496
US

IV. Provider business mailing address

3433 W SHAW AVE STE 102
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-410-8302
  • Fax: 559-410-8612
Mailing address:
  • Phone: 559-581-4051
  • Fax:

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: