MEDICARE: MR. IGNACIO RUIZ SR. DENTIST D.D.S.

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
1	1223G0001X	General Practice Dentistry	41673	CA

General Provider Information

NPI Number	:	1023222569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IGNACIO RUIZ SR. DENTIST D.D.S.

Provider Business Mailing Address
First Line	:	312 N SOTO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1815
Country	:	US
Telephone Number	:	323-263-3918
Fax Number	:	323-263-4521

Provider Business Practice Location Address
First Line	:	312 N SOTO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1815
Country	:	US
Telephone Number	:	323-263-3918
Fax Number	:	323-263-4521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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