Healthcare Provider Details

I. General information

NPI: 1427480235
Provider Name (Legal Business Name): MR. FERNANDO J G RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/25/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 N RANCHO DR
LAS VEGAS NV
89130-3180
US

IV. Provider business mailing address

1120 CEDAR CREEK CT APT 109
MODESTO CA
95355-5244
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4300
  • Fax:
Mailing address:
  • Phone: 702-773-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: