Healthcare Provider Details

I. General information

NPI: 1235550245
Provider Name (Legal Business Name): LUIS EDUARDO RUIZ-RESTREPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS EDUARDO RUIZ M.D.

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W E ST
TEHACHAPI CA
93561-1608
US

IV. Provider business mailing address

P.O. BOX 663 116 WEST E STREET
TEHACHAPI CA
93581
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-1004
  • Fax:
Mailing address:
  • Phone: 661-822-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC041382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: