Healthcare Provider Details

I. General information

NPI: 1598582512
Provider Name (Legal Business Name): CAIO AUGUSTO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 6TH ST APT 100
SANTA MONICA CA
90401-1657
US

IV. Provider business mailing address

1234 6TH ST APT 100
SANTA MONICA CA
90401-1657
US

V. Phone/Fax

Practice location:
  • Phone: 323-762-5250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: