Healthcare Provider Details

I. General information

NPI: 1093847055
Provider Name (Legal Business Name): MRS. MARISOL RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD RM 200
SALINAS CA
93906-3122
US

IV. Provider business mailing address

1000 S MAIN ST STE 105
SALINAS CA
93901-2353
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax:
Mailing address:
  • Phone: 831-784-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: