Provider Demographics
NPI:1235250556
Name:RUIZ, YOSHIO WALTER (MSW)
Entity Type:Individual
Prefix:
First Name:YOSHIO
Middle Name:WALTER
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:MORELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30259-0458
Mailing Address - Country:US
Mailing Address - Phone:770-251-0530
Mailing Address - Fax:770-251-8656
Practice Address - Street 1:37 CALUMET PKWY # J
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-251-0530
Practice Address - Fax:770-251-8656
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004062104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker