Provider Demographics
NPI:1275024424
Name:RUIZ-MALCA, GLADYS GUADALUPE (ATC)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:GUADALUPE
Last Name:RUIZ-MALCA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 CASWELL PL
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3303
Mailing Address - Country:US
Mailing Address - Phone:202-455-9572
Mailing Address - Fax:
Practice Address - Street 1:8507 CASWELL PL
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3303
Practice Address - Country:US
Practice Address - Phone:202-455-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer