Provider Demographics
NPI:1508981085
Name:AVILA, RUTH JUAREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:JUAREZ
Last Name:AVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8199 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2177
Mailing Address - Country:US
Mailing Address - Phone:559-438-6212
Mailing Address - Fax:559-439-3919
Practice Address - Street 1:5044 N BARTON AVE
Practice Address - Street 2:MS HC81
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-2734
Practice Address - Fax:559-278-7609
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG76868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF90639Medicare UPIN