Healthcare Provider Details

I. General information

NPI: 1649740671
Provider Name (Legal Business Name): SANDRA RUIZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1243
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5823
  • Fax: 575-527-5886
Mailing address:
  • Phone: 575-526-6682
  • Fax: 575-523-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-11456
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-1191
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: