Provider Demographics
NPI:1619950953
Name:MORENO-RUIZ, NILDA (MD)
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:
Last Name:MORENO-RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NILDA
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-3915
Mailing Address - Fax:916-853-7794
Practice Address - Street 1:1779 DOMINICAN WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1526
Practice Address - Country:US
Practice Address - Phone:831-479-4966
Practice Address - Fax:831-479-7967
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038582207V00000X
CAC130527207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2109026Medicaid
MAA38952Medicare ID - Type Unspecified
MA2109026Medicaid