Provider Demographics
NPI:1346848116
Name:RUIZ, KERRY MICHAEL
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:MICHAEL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1210
Mailing Address - Country:US
Mailing Address - Phone:225-937-9736
Mailing Address - Fax:
Practice Address - Street 1:2378 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1210
Practice Address - Country:US
Practice Address - Phone:225-937-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer