Healthcare Provider Details

I. General information

NPI: 1104885391
Provider Name (Legal Business Name): LOURDES R BORGES RUIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LIVINGSTON AVE STE 222
SAINT PAUL MN
55118-5938
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 612-850-0923
  • Fax: 728-203-9709
Mailing address:
  • Phone: 952-853-8800
  • Fax: 612-371-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41445
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: