Provider Demographics
NPI:1073971495
Name:RUIZ, SARAH (PHD, RD, LD, CDCES)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHD, RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E YANDELL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3743
Mailing Address - Country:US
Mailing Address - Phone:915-262-6192
Mailing Address - Fax:833-526-6362
Practice Address - Street 1:2601 E YANDELL DR STE 104
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3743
Practice Address - Country:US
Practice Address - Phone:915-262-6192
Practice Address - Fax:833-526-6362
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21600535133VN1006X
TXDT83186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX397783702Medicaid