Healthcare Provider Details

I. General information

NPI: 1760036792
Provider Name (Legal Business Name): GINA MARIE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 HIGHWAY 528 NE
RIO RANCHO NM
87144-7650
US

IV. Provider business mailing address

3777 HIGHWAY 528 NE
RIO RANCHO NM
87144-7650
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-2590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR66080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: