Provider Demographics
NPI:1427376557
Name:RUIZ, MONICA ISABELLA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ISABELLA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4915
Mailing Address - Country:US
Mailing Address - Phone:214-638-2000
Mailing Address - Fax:833-989-0323
Practice Address - Street 1:1355 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4915
Practice Address - Country:US
Practice Address - Phone:214-638-2000
Practice Address - Fax:833-989-0323
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6629207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8SW421OtherBLUE CROSS BLUE SHIELD
TX283514201Medicaid
TX8CW428OtherBLUE CROSS BLUE SHIELD
TX283514202Medicaid
TXP00979864OtherRAILROAD MEDICARE
TX283514201Medicaid
TXP00979864OtherRAILROAD MEDICARE