=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275725061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARITZA ELENA RUIZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2653 ELM AVE STE 200
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-728-5000
-----------------------------------------------------
Fax | 562-933-1815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12448 JUNIPER TER
-----------------------------------------------------
City | SANTA FE SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90670-3848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-665-6097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0207X
-----------------------------------------------------
Taxonomy Name | Pediatric Hematology & Oncology Physician
-----------------------------------------------------
License Number | A107484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------