Provider Demographics
NPI:1235623356
Name:RUIZ, CRISTAL (BS)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CORP CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5749 CRESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:CORP CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-3816
Practice Address - Country:US
Practice Address - Phone:361-726-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39559261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech