Provider Demographics
NPI:1053469932
Name:RUIZ, LUIS ANTONIO (CADCII)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ANTONIO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:ANTONIO
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADCII
Mailing Address - Street 1:3305 G ST BLDG G
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0964
Mailing Address - Country:US
Mailing Address - Phone:209-381-6880
Mailing Address - Fax:209-723-6220
Practice Address - Street 1:3305 G ST BLDG G
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0964
Practice Address - Country:US
Practice Address - Phone:209-381-6880
Practice Address - Fax:209-723-6220
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3525687101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)