Provider Demographics
NPI:1225433162
Name:RUIZ, EYDIE
Entity Type:Individual
Prefix:
First Name:EYDIE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 W SHAW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3229
Mailing Address - Country:US
Mailing Address - Phone:559-581-4051
Mailing Address - Fax:
Practice Address - Street 1:520 W LACEY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4496
Practice Address - Country:US
Practice Address - Phone:559-410-8302
Practice Address - Fax:559-410-8612
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760837942OtherMEDICAL