Provider Demographics
NPI:1154461788
Name:RUIZ, LEOPOLDO IV (CPHT)
Entity Type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:
Last Name:RUIZ
Suffix:IV
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 CHIMAYO RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6325
Mailing Address - Country:US
Mailing Address - Phone:956-796-9600
Mailing Address - Fax:956-729-9700
Practice Address - Street 1:6801 MCPHERSON RD STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6403
Practice Address - Country:US
Practice Address - Phone:956-796-9600
Practice Address - Fax:956-729-9700
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108982183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician