Healthcare Provider Details

I. General information

NPI: 1578599809
Provider Name (Legal Business Name): R RUIZ M D A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S RIVERSIDE AVE
RIALTO CA
92376-6523
US

IV. Provider business mailing address

436 S RIVERSIDE AVE
RIALTO CA
92376-6523
US

V. Phone/Fax

Practice location:
  • Phone: 909-877-8868
  • Fax: 909-877-0008
Mailing address:
  • Phone: 909-877-8868
  • Fax:

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