Healthcare Provider Details

I. General information

NPI: 1164813424
Provider Name (Legal Business Name): KIRA ARACELY RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 COSMOS AVE
AKRON OH
44319-3109
US

IV. Provider business mailing address

3121 COSMOS AVE
AKRON OH
44319-3109
US

V. Phone/Fax

Practice location:
  • Phone: 330-703-1117
  • Fax:
Mailing address:
  • Phone: 330-703-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: