MEDICARE: MS. ALMA D 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	246RM2200X	Medical Laboratory Technician	25408754	IL

General Provider Information

NPI Number	:	1801171715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALMA D RUIZ

Provider Business Mailing Address
First Line	:	3249 MANNY AGUILERA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-2760
Country	:	US
Telephone Number	:	915-204-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	3249 MANNY AGUILERA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-2760
Country	:	US
Telephone Number	:	915-204-7667
Fax Number	:

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

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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