Healthcare Provider Details

I. General information

NPI: 1467804856
Provider Name (Legal Business Name): JOBINA SUSANNAH RUIZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1486 COMMONWEALTH AVE APT 6
BRIGHTON MA
02135-4526
US

IV. Provider business mailing address

DEPT# 42065 PO BOX 650823
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 347-387-6065
  • Fax:
Mailing address:
  • Phone: 602-242-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number240300
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN128055
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9432765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: