Provider Demographics
NPI:1114656717
Name:RUIZ, CLAUDIO OMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:CLAUDIO
Middle Name:OMAR
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13668 GAGER ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3811
Mailing Address - Country:US
Mailing Address - Phone:818-497-0939
Mailing Address - Fax:
Practice Address - Street 1:18433 ROSCOE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4129
Practice Address - Country:US
Practice Address - Phone:818-435-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118995183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician