Healthcare Provider Details

I. General information

NPI: 1598348971
Provider Name (Legal Business Name): ADRIANA VAZQUEZ RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 ROBERT ST S
WEST ST PAUL MN
55118-1444
US

IV. Provider business mailing address

882 ROBERT ST S
WEST ST PAUL MN
55118-1444
US

V. Phone/Fax

Practice location:
  • Phone: 651-330-7306
  • Fax: 651-348-2345
Mailing address:
  • Phone: 651-330-7306
  • Fax: 651-348-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: