Healthcare Provider Details

I. General information

NPI: 1629515168
Provider Name (Legal Business Name): DR. YESENIA M. RUIZ, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6498 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

IV. Provider business mailing address

6498 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-1111
  • Fax:
Mailing address:
  • Phone: 210-828-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number257523656
License Number StateTX

VIII. Authorized Official

Name: YESENIA RUIZ
Title or Position: OWNER
Credential: MD
Phone: 210-358-9724