Provider Demographics
NPI:1003157959
Name:RUIZ, BIENVENIDA A (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BIENVENIDA
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 GLEASON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5102
Mailing Address - Country:US
Mailing Address - Phone:718-753-3114
Mailing Address - Fax:718-960-1370
Practice Address - Street 1:1650 SELWYN AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7628
Practice Address - Country:US
Practice Address - Phone:718-960-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant