Provider Demographics
NPI:1306205208
Name:RUIZ, LORENA HERMINIA (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:HERMINIA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:HERMINIA
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27525 SUNRAY CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2816
Mailing Address - Country:US
Mailing Address - Phone:951-788-3180
Mailing Address - Fax:
Practice Address - Street 1:4445 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4135
Practice Address - Country:US
Practice Address - Phone:951-788-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003658363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care