Provider Demographics
NPI:1235550245
Name:RUIZ-RESTREPO, LUIS EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:RUIZ-RESTREPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:EDUARDO
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 663
Mailing Address - Street 2:116 WEST E STREET
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581
Mailing Address - Country:US
Mailing Address - Phone:661-822-1004
Mailing Address - Fax:
Practice Address - Street 1:116 W E ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1608
Practice Address - Country:US
Practice Address - Phone:661-822-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC041382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134294788Medicaid