Provider Demographics
NPI:1164203097
Name:RUIZ, ELLERY PHILIP JR
Entity Type:Individual
Prefix:MR
First Name:ELLERY
Middle Name:PHILIP
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 KIFER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-0708
Mailing Address - Country:US
Mailing Address - Phone:408-444-0772
Mailing Address - Fax:
Practice Address - Street 1:3311 KIFER RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0708
Practice Address - Country:US
Practice Address - Phone:510-424-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health