Provider Demographics
NPI:1114653615
Name:RUIZ, CARINA (COTA)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77564 COUNTRY CLUB DR STE 401B
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6246
Mailing Address - Country:US
Mailing Address - Phone:760-772-2838
Mailing Address - Fax:760-772-2883
Practice Address - Street 1:77564 COUNTRY CLUB DR STE 401B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6246
Practice Address - Country:US
Practice Address - Phone:760-772-2838
Practice Address - Fax:760-772-2883
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5701224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant