Provider Demographics
NPI:1356005474
Name:RUIZ, CHARLOTTE MARIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 E OSBORN RD APT 24W
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7456
Mailing Address - Country:US
Mailing Address - Phone:480-521-2122
Mailing Address - Fax:
Practice Address - Street 1:9059 W LAKE PLEASANT PKWY STE E540
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8396
Practice Address - Country:US
Practice Address - Phone:623-234-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant