Healthcare Provider Details

I. General information

NPI: 1376702902
Provider Name (Legal Business Name): CLAUDIO A RUIZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

IV. Provider business mailing address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-8100
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-795-8100
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number688152
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number688152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: