Provider Demographics
NPI:1386038016
Name:RUIZ, JONATHON MARTIN
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:MARTIN
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 1:11497 N BISCAYNE LN
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46732-9651
Mailing Address - Country:US
Mailing Address - Phone:574-527-3659
Mailing Address - Fax:
Practice Address - Street 1:440 N BRAINARD STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:574-527-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer