MEDICARE: JORGE LOPEZ RUIZ P.P.S.

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1588489850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LOPEZ RUIZ P.P.S.

Provider Business Mailing Address
First Line	:	31495 ROBERT RD
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3343
Country	:	US
Telephone Number	:	760-343-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	31495 ROBERT RD
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3343
Country	:	US
Telephone Number	:	760-343-7570
Fax Number	:

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

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “ JORGE LOPEZ RUIZ P.P.S.” Practice Location

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