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NPI Code Detail

MEDICARE: MARIO RUIZ PMHNP-BC

MEDICARE: MARIO RUIZ PMHNP-BC
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
1163W00000XRegistered Nurse95214650CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner95030403CA

General Provider Information

NPI Number : 1386469427
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO RUIZ PMHNP-BC
Provider Business Mailing Address
First Line : 1004 W WEST COVINA PKWY # 477
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-2810
Country : US
Telephone Number : 323-947-1167
Fax Number :
Provider Business Practice Location Address
First Line : 675 W FOOTHILL BLVD STE 200
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-3475
Country : US
Telephone Number : 925-282-1778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 01/05/2026

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Directions to “ MARIO RUIZ PMHNP-BC” Practice Location

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