Provider Demographics
NPI:1255655189
Name:RUIZ, SERGIO (MBA)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MBA
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 372
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NM
Mailing Address - Zip Code:88048-0372
Mailing Address - Country:US
Mailing Address - Phone:575-915-2224
Mailing Address - Fax:
Practice Address - Street 1:880 ANTHONY DR STE 3E
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9346
Practice Address - Country:US
Practice Address - Phone:575-915-2224
Practice Address - Fax:575-882-1879
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker