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General NPI Number Information
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NPI Number | 1124749700
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Entity Type | Organization
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Legal Business Name | JONATHAN PATRICK RUIZ
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 10/08/2022
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Provider Practice Location Address
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Address Line | 1900 LIGHT RD APT 103
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City | OSWEGO
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State | IL
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Zip | 60543-9013
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Country | US
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Telephone | 815-341-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 LIGHT RD APT 103
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City | OSWEGO
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State | IL
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Zip | 60543-9013
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Country | US
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Telephone | 815-341-2599
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | JONATHAN P RUIZ
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Credential | CSFA
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Telephone | 815-341-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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