Provider Demographics
NPI:1124373766
Name:RUIZ, ZANDRA YVETTE (LMT)
Entity Type:Individual
Prefix:
First Name:ZANDRA
Middle Name:YVETTE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 4653
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8653
Mailing Address - Country:US
Mailing Address - Phone:503-391-9222
Mailing Address - Fax:503-363-8193
Practice Address - Street 1:925 COMMERCIAL ST SE STE 260
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4288
Practice Address - Country:US
Practice Address - Phone:503-391-9222
Practice Address - Fax:506-363-8193
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist