Provider Demographics
NPI:1588632673
Name:RUIZ, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1524
Mailing Address - Country:US
Mailing Address - Phone:925-838-6533
Mailing Address - Fax:
Practice Address - Street 1:200 PORTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1524
Practice Address - Country:US
Practice Address - Phone:925-838-6500
Practice Address - Fax:925-838-6542
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12775Medicare UPIN