Healthcare Provider Details

I. General information

NPI: 1083523773
Provider Name (Legal Business Name): JORDAN MANUEL RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 W LAKE MEAD BLVD STE 300
LAS VEGAS NV
89128-8380
US

IV. Provider business mailing address

7251 W LAKE MEAD BLVD STE 300
LAS VEGAS NV
89128-8380
US

V. Phone/Fax

Practice location:
  • Phone: 702-562-4344
  • Fax:
Mailing address:
  • Phone: 702-562-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: