=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134648728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FIORELA RUIZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 BRANNON RD. BLDG. 96857
-----------------------------------------------------
City | SCHOFIELD BARRACKS
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-433-8387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68-172 AU ST
-----------------------------------------------------
City | WAIALUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96791-9452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-298-1652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C010936
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------