Provider Demographics
NPI:1467804856
Name:RUIZ, JOBINA SUSANNAH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JOBINA
Middle Name:SUSANNAH
Last Name:RUIZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT# 42065 PO BOX 650823
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:602-242-4484
Mailing Address - Fax:
Practice Address - Street 1:1486 COMMONWEALTH AVE
Practice Address - Street 2:APT 6
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-4526
Practice Address - Country:US
Practice Address - Phone:347-387-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ240300367500000X
AZRN128055367500000X
FL9432765367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered