Healthcare Provider Details

I. General information

NPI: 1104404201
Provider Name (Legal Business Name): CAROLINA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 1600
LOS ANGELES CA
90017-4007
US

IV. Provider business mailing address

427 S MANHATTAN PL APT 201
LOS ANGELES CA
90020-5031
US

V. Phone/Fax

Practice location:
  • Phone: 213-250-5333
  • Fax:
Mailing address:
  • Phone: 786-420-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34952-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: