Provider Demographics
NPI:1417290529
Name:RUIZ, JEANETTE (MD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:DEJONGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3445 EXECUTIVE CENTER DR
Mailing Address - Street 2:STE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1678
Mailing Address - Country:US
Mailing Address - Phone:512-579-4000
Mailing Address - Fax:512-222-0146
Practice Address - Street 1:3445 EXECUTIVE CENTER DR
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1678
Practice Address - Country:US
Practice Address - Phone:512-579-4000
Practice Address - Fax:512-222-0146
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS4859207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program