Provider Demographics
NPI:1407133630
Name:RUIZQUEZ, ANDREA L (CPM, LDM)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:RUIZQUEZ
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552A 35TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2124
Mailing Address - Country:US
Mailing Address - Phone:510-610-2164
Mailing Address - Fax:
Practice Address - Street 1:552A 35TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2124
Practice Address - Country:US
Practice Address - Phone:510-610-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR155539176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife