MEDICARE: ANABEL RUIZ ATC, LAT

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	2255A2300X	Athletic Trainer	096.005116	IL

General Provider Information

NPI Number	:	1891326740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANABEL RUIZ ATC, LAT

Provider Business Mailing Address
First Line	:	2847 N NORMANDY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4816
Country	:	US
Telephone Number	:	773-860-3047
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 N NORMANDY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4816
Country	:	US
Telephone Number	:	773-860-3047
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	06/02/2023

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