Provider Demographics
NPI:1528606464
Name:RUIZ, MARK NATHANIEL HEMEDES
Entity Type:Individual
Prefix:
First Name:MARK NATHANIEL
Middle Name:HEMEDES
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-3042
Mailing Address - Country:US
Mailing Address - Phone:559-636-1603
Mailing Address - Fax:
Practice Address - Street 1:1455 E NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3042
Practice Address - Country:US
Practice Address - Phone:559-636-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist