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NPI Code Detail

MEDICARE: MR. ELIAS OMAR RUILOBA MD

MEDICARE: MR. ELIAS OMAR RUILOBA MD
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
12084P0800XPsychiatry Physician25458AZ

General Provider Information

NPI Number : 1124014196
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ELIAS OMAR RUILOBA MD
Provider Business Mailing Address
First Line : 20950 N TATUM BLVD STE 380
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4258
Country : US
Telephone Number : 480-626-7584
Fax Number : 480-210-0230
Provider Business Practice Location Address
First Line : 20950 N TATUM BLVD STE 380
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4258
Country : US
Telephone Number : 480-626-7584
Fax Number : 480-210-0230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 05/18/2026

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