Provider Demographics
NPI:1033881065
Name:RUIZ, ABIGAIL (DDS)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25261 LA MAR RD APT C
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3023
Mailing Address - Country:US
Mailing Address - Phone:423-255-1059
Mailing Address - Fax:
Practice Address - Street 1:31843 RANCHO CALIFORNIA RD STE 300
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5120
Practice Address - Country:US
Practice Address - Phone:951-676-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1069281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice