Provider Demographics
NPI:1588798284
Name:RUIZ, GUILLERMO W (AUD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:W
Last Name:RUIZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:W
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:17418 CANYON HOLW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2604
Mailing Address - Country:US
Mailing Address - Phone:210-573-0063
Mailing Address - Fax:210-479-2904
Practice Address - Street 1:17418 CANYON HOLW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2604
Practice Address - Country:US
Practice Address - Phone:210-573-0063
Practice Address - Fax:210-479-2904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50651231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094633701Medicaid
TX094633703Medicaid
TX094633701Medicaid