Provider Demographics
NPI:1376179002
Name:RUIZ, EDWARD G (RD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:RUIZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30075 AVENIDA LOS NINOS
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2810
Mailing Address - Country:US
Mailing Address - Phone:619-386-7336
Mailing Address - Fax:760-406-5565
Practice Address - Street 1:30075 AVENIDA LOS NINOS
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-2810
Practice Address - Country:US
Practice Address - Phone:619-386-7336
Practice Address - Fax:760-406-5565
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86101037174H00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator