Provider Demographics
NPI:1033766134
Name:RUIZ, VANESSA LORRAINE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LORRAINE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15236 NAVA ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-3830
Mailing Address - Country:US
Mailing Address - Phone:707-273-7742
Mailing Address - Fax:
Practice Address - Street 1:15236 NAVA ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-3830
Practice Address - Country:US
Practice Address - Phone:707-273-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician