Healthcare Provider Details

I. General information

NPI: 1003266644
Provider Name (Legal Business Name): MARIO RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C. ALVARO OBREGON 63 COL. JARDIN
MATAMOROS TAMAULIPAS
87330
MX

IV. Provider business mailing address

535 HABANA ST
BROWNSVILLE TX
78526-1897
US

V. Phone/Fax

Practice location:
  • Phone: 868-813-3022
  • Fax: 868-813-6984
Mailing address:
  • Phone: 956-572-6880
  • Fax: 956-541-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3223659
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: