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General NPI Number Information
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NPI Number | 1063877546
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Entity Type | Individual
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Provider Name | LARRY RICHARD RUIZ CSAC
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Gender | Male
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 1787 WILI PA LOOP STE 7
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City | WAILUKU
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State | HI
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Zip | 96793-1271
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Country | US
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Telephone | 808-283-0737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81690
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City | HAIKU
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State | HI
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Zip | 96708-1690
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Country | US
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Telephone | 808-283-0737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1233-05
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License Number State | HI
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