Provider Demographics
NPI:1134294788
Name:LUIS E RUIZ-RESTREPO MD INC
Entity Type:Organization
Organization Name:LUIS E RUIZ-RESTREPO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUIZ-RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-822-1004
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0663
Mailing Address - Country:US
Mailing Address - Phone:661-822-1004
Mailing Address - Fax:661-822-3603
Practice Address - Street 1:116 WEST E. STREET
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-822-1004
Practice Address - Fax:661-822-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41382261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C413820Medicaid
CA00C413820Medicaid