Provider Demographics
NPI:1518167980
Name:RUIZ, JUAN MAXIMINO (PTA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MAXIMINO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11429 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3143
Mailing Address - Country:US
Mailing Address - Phone:818-766-9551
Mailing Address - Fax:818-508-1838
Practice Address - Street 1:11429 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3143
Practice Address - Country:US
Practice Address - Phone:818-766-9551
Practice Address - Fax:818-508-1838
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4838225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant