Provider Demographics
NPI:1326695115
Name:RUIZ, TIMOTHY (CCP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2236
Mailing Address - Country:US
Mailing Address - Phone:956-533-1852
Mailing Address - Fax:
Practice Address - Street 1:520 E BLUEBIRD AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2236
Practice Address - Country:US
Practice Address - Phone:956-533-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FPF00000175242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty