Healthcare Provider Details

I. General information

NPI: 1043241821
Provider Name (Legal Business Name): RUBEN RUIZ M D A MEDICAL 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

403 W F ST
ONTARIO CA
91762-3207
US

IV. Provider business mailing address

403 W F ST
ONTARIO CA
91762-3207
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-3288
  • Fax: 909-988-6767
Mailing address:
  • Phone: 909-988-3288
  • Fax: 909-988-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG52245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
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