Provider Demographics
NPI:1609013473
Name:RUIZ, CESAR E (SLPD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:E
Last Name:RUIZ
Suffix:
Gender:M
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3803
Mailing Address - Country:US
Mailing Address - Phone:610-639-1264
Mailing Address - Fax:610-284-4787
Practice Address - Street 1:4130 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3803
Practice Address - Country:US
Practice Address - Phone:610-639-1264
Practice Address - Fax:610-284-4787
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003576L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL003576LOtherLICENSE