Healthcare Provider Details

I. General information

NPI: 1952599789
Provider Name (Legal Business Name): JENNIFER RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W OLIVE AVE STE H
MERCED CA
95348-1900
US

IV. Provider business mailing address

1180 W OLIVE AVE STE H
MERCED CA
95348-1900
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-1295
  • Fax:
Mailing address:
  • Phone: 209-725-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: