Healthcare Provider Details

I. General information

NPI: 1306385976
Provider Name (Legal Business Name): TERESITA RUIZ CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE D
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

2252 BEN LN
SANTA FE NM
87507-3406
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-0372
  • Fax: 505-471-0372
Mailing address:
  • Phone: 505-471-0372
  • Fax: 505-471-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1857
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: