Provider Demographics
NPI:1023222569
Name:RUIZ, IGNACIO SR (DENTIST DDS)
Entity Type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:
Last Name:RUIZ
Suffix:SR
Gender:M
Credentials:DENTIST DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N SOTO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1815
Mailing Address - Country:US
Mailing Address - Phone:323-263-3918
Mailing Address - Fax:323-263-4521
Practice Address - Street 1:312 N SOTO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1815
Practice Address - Country:US
Practice Address - Phone:323-263-3918
Practice Address - Fax:323-263-4521
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice