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General NPI Number Information
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NPI Number | 1548425309
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Entity Type | Individual
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Provider Name | JOSE ANTHONY RUIZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 3623 LATROBE DR STE 216
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City | CHARLOTTE
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State | NC
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Zip | 28211-2117
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Country | US
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Telephone | 704-332-1291
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 221249
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City | CHARLOTTE
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State | NC
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Zip | 28222-1249
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Country | US
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Telephone | 980-208-1704
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Fax | 425-563-1374
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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 | PA60528245
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License Number State | WA
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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 | 001001538
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License Number State | NC
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