Provider Demographics
NPI:1154094175
Name:RUIZ, MELANIE FULTON (NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:FULTON
Last Name:RUIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:FULTON
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:609 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2639
Mailing Address - Country:US
Mailing Address - Phone:210-687-1110
Mailing Address - Fax:210-687-1118
Practice Address - Street 1:609 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2639
Practice Address - Country:US
Practice Address - Phone:210-687-1110
Practice Address - Fax:210-697-1118
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143267207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty