Provider Demographics
NPI:1508312661
Name:RUIZ, CELENA (PA)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CELENA
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2851 S AVENUE B STE 2601
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7748
Mailing Address - Country:US
Mailing Address - Phone:928-366-1062
Mailing Address - Fax:928-366-1063
Practice Address - Street 1:2851 S AVENUE B STE 2601
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7748
Practice Address - Country:US
Practice Address - Phone:928-366-1062
Practice Address - Fax:928-366-1063
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9896363A00000X
HIAMD-763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty