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General NPI Number Information
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NPI Number | 1497881692
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Entity Type | Individual
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Provider Name | ENRIQUE RUIZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 632 DEL PRADO BLVD N STE 201
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City | CAPE CORAL
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State | FL
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Zip | 33909-2278
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Country | US
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Telephone | 239-829-7102
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Fax |
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Provider Business Mailing Address
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Address Line | 632 DEL PRADO BLVD N STE 201
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City | CAPE CORAL
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State | FL
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Zip | 33909-2278
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Country | US
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Telephone | 239-829-7102
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104245
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-00772
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA91042445
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License Number State | FL
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