Provider Demographics
NPI:1598348971
Name:RUIZ, ADRIANA VAZQUEZ
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:VAZQUEZ
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1444
Mailing Address - Country:US
Mailing Address - Phone:651-330-7306
Mailing Address - Fax:651-348-2345
Practice Address - Street 1:882 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1444
Practice Address - Country:US
Practice Address - Phone:651-330-7306
Practice Address - Fax:651-348-2345
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1105167OtherDHS