Provider Demographics
NPI:1073658696
Name:RUIZ, CLAUDIA R (PA)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:R
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WEST ATEN ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-7730
Mailing Address - Fax:760-355-7731
Practice Address - Street 1:1550 NORTH IMPERIAL AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-353-4710
Practice Address - Fax:760-353-6015
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47484ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0066310OtherGROUP #
CAWPA17421AOtherMEDICARE PTAN
CAQ75629Medicare UPIN
CAZZZ47484ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0066310OtherGROUP #