Healthcare Provider Details

I. General information

NPI: 1821898677
Provider Name (Legal Business Name): NATHAN ANDREW RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 KANSAS AVE
SOUTH GATE CA
90280-4026
US

IV. Provider business mailing address

2816 KANSAS AVE
SOUTH GATE CA
90280-4026
US

V. Phone/Fax

Practice location:
  • Phone: 323-423-2689
  • Fax: --
Mailing address:
  • Phone: 323-423-2689
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: