Provider Demographics
NPI:1003905167
Name:RUIZ, MARIA DEL REFUGIO RIVERA (LPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA DEL REFUGIO
Middle Name:RIVERA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MR
Other - First Name:REFUGIO
Other - Middle Name:RIVERA
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPS
Mailing Address - Street 1:200 S CITRON ST APT 124
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3673
Mailing Address - Country:US
Mailing Address - Phone:714-758-8146
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:SUITE # 890
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3640
Practice Address - Country:US
Practice Address - Phone:714-480-6610
Practice Address - Fax:714-480-6613
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22709167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician