Healthcare Provider Details

I. General information

NPI: 1992049191
Provider Name (Legal Business Name): MS. JESSICA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W. HICKORY ST.
DEMING NM
88030
US

IV. Provider business mailing address

1320 S. SOLANO
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-2174
  • Fax: 575-544-4821
Mailing address:
  • Phone: 575-527-7900
  • Fax: 575-571-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: