Healthcare Provider Details

I. General information

NPI: 1902417447
Provider Name (Legal Business Name): TODD RUIZ CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WASHBURN AVE APT 38
LOUISVILLE KY
40222-6793
US

IV. Provider business mailing address

4141 SOUTHWEST FWY STE 410
HOUSTON TX
77027-7422
US

V. Phone/Fax

Practice location:
  • Phone: 425-985-4025
  • Fax:
Mailing address:
  • Phone: 713-255-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number4463
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: