MEDICARE: JESUS HILARIO 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	363A00000X	Physician Assistant	1718-P.A.	PR

General Provider Information

NPI Number	:	1427739259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS HILARIO RUIZ

Provider Business Mailing Address
First Line	:	1620 VICTOR LOPEZ DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6107
Country	:	US
Telephone Number	:	915-258-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 VICTOR LOPEZ DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6107
Country	:	US
Telephone Number	:	915-258-2175
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	08/11/2023

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Directions to “ JESUS HILARIO RUIZ ” Practice Location

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