MEDICARE: JORGE RUIZ LOPEZ M.D.

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	207Q00000X	Family Medicine Physician	G71947	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881705556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE RUIZ LOPEZ M.D.

Provider Business Mailing Address
First Line	:	10 BRAMBLEWOOD
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-1280
Country	:	US
Telephone Number	:	714-832-5980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 S BRISTOL ST
Second Line	:	SUITE 100
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-825-1844
Fax Number	:	714-825-1848

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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