Provider Demographics
NPI:1457458135
Name:RUIZ, CARA BAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:BAILEY
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1920 E KATELLA AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5146
Mailing Address - Country:US
Mailing Address - Phone:714-633-7111
Mailing Address - Fax:714-633-2903
Practice Address - Street 1:1920 E KATELLA AVE
Practice Address - Street 2:SUITE M
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5146
Practice Address - Country:US
Practice Address - Phone:714-633-7111
Practice Address - Fax:714-633-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68455Medicaid