Provider Demographics
NPI:1336511468
Name:RUIZ, SANDRA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 SLOAT RD
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-2830
Mailing Address - Country:US
Mailing Address - Phone:831-277-5984
Mailing Address - Fax:831-920-0501
Practice Address - Street 1:3076 SLOAT RD
Practice Address - Street 2:
Practice Address - City:PEBBLE BEACH
Practice Address - State:CA
Practice Address - Zip Code:93953-2830
Practice Address - Country:US
Practice Address - Phone:831-277-5984
Practice Address - Fax:831-920-0501
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X, 343900000X
CA538883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)