MEDICARE: RAQUEL RUIZ

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1235720038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL RUIZ

Provider Business Mailing Address
First Line	:	6022 CAPROCK CT APT 412
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3921
Country	:	US
Telephone Number	:	915-330-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3719 EDGAR PARK AVE APT 1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-2603
Country	:	US
Telephone Number	:	915-330-3086
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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Directions to “ RAQUEL RUIZ ” Practice Location

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