Provider Demographics
NPI:1598961708
Name:RUIZ, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7278
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-7278
Mailing Address - Country:US
Mailing Address - Phone:760-564-9205
Mailing Address - Fax:760-771-6243
Practice Address - Street 1:47110 WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2186
Practice Address - Country:US
Practice Address - Phone:760-564-9205
Practice Address - Fax:760-771-6243
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2023-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA104554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA727Medicare PIN