Provider Demographics
NPI:1558335414
Name:RUIZ, CECILIA GONZALEZ (PA-C)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:GONZALEZ
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10158 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4435
Mailing Address - Country:US
Mailing Address - Phone:619-562-1140
Mailing Address - Fax:619-562-5362
Practice Address - Street 1:10158 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071
Practice Address - Country:US
Practice Address - Phone:619-562-1140
Practice Address - Fax:619-562-5362
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126702OtherMEDICARE PTAN
AZ393450Medicaid