Healthcare Provider Details

I. General information

NPI: 1245261023
Provider Name (Legal Business Name): R RUIZ M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

IV. Provider business mailing address

833 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

V. Phone/Fax

Practice location:
  • Phone: 213-276-6776
  • Fax:
Mailing address:
  • Phone: 323-712-4811
  • Fax: 844-302-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG52245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUBEN RUIZ
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 562-201-2508