Healthcare Provider Details

I. General information

NPI: 1598249823
Provider Name (Legal Business Name): ADRIAN RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2018
Last Update Date: 09/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15109 STANLEAF DR
LA MIRADA CA
90638-4621
US

IV. Provider business mailing address

15109 STANLEAF DR
LA MIRADA CA
90638-4621
US

V. Phone/Fax

Practice location:
  • Phone: 714-326-4456
  • Fax:
Mailing address:
  • Phone: 714-326-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number29904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: