Healthcare Provider Details

I. General information

NPI: 1053803908
Provider Name (Legal Business Name): RENEE RUIZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349A E AVENUE K6
LANCASTER CA
93535-4548
US

IV. Provider business mailing address

349A E AVENUE K6
LANCASTER CA
93535-4548
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-4260
  • Fax:
Mailing address:
  • Phone: 661-723-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number706378
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number706378
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number706378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: