Provider Demographics
NPI:1235310426
Name:RUIZ, ROBERTO JR (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ENCINO ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6914
Mailing Address - Country:US
Mailing Address - Phone:512-787-1093
Mailing Address - Fax:
Practice Address - Street 1:328 ENCINO ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6914
Practice Address - Country:US
Practice Address - Phone:512-787-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant