Healthcare Provider Details

I. General information

NPI: 1902736531
Provider Name (Legal Business Name): GABREILLE ANGELICA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 FLAT ROCK DR
RIVERSIDE CA
92505-7115
US

IV. Provider business mailing address

4199 FLAT ROCK DR STE 100
RIVERSIDE CA
92505-7116
US

V. Phone/Fax

Practice location:
  • Phone: 951-433-7464
  • Fax:
Mailing address:
  • Phone: 951-433-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: