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NPI Code Detail

MEDICARE: RUIZ ANESTHESIA INC

MEDICARE: RUIZ ANESTHESIA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1003451535
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUIZ ANESTHESIA INC
Provider Business Mailing Address
First Line : 5 HOLLAND STE 101
Second Line :
City : IRVINE
State : CA
Zip : 92618-2568
Country : US
Telephone Number : 949-588-2190
Fax Number :
Provider Business Practice Location Address
First Line : 29300 PORTOLA PKWY STE A
Second Line :
City : LAKE FOREST
State : CA
Zip : 92630-8741
Country : US
Telephone Number : 949-305-6336
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MATTHEW RUIZ
Credential : CRNA
Telephone Number : 760-218-8303
Provider Enumeration Date : 11/07/2019
Last Update Date : 05/14/2020

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