MEDICARE: RUBEN M RUIZ III MEDICAL CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1447653050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBEN M RUIZ III MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3012 SAN GABRIEL BLVD
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2536
Country	:	US
Telephone Number	:	626-572-8692
Fax Number	:	626-572-9736

Provider Business Practice Location Address
First Line	:	3012 SAN GABRIEL BLVD
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2536
Country	:	US
Telephone Number	:	626-572-8692
Fax Number	:	626-572-9736

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUBEN M RUIZ III
Credential	:	M. D.
Telephone Number	:	626-593-1233

Provider Enumeration Date	:	09/27/2014
Last Update Date	:	04/19/2017

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