Provider Demographics
NPI:1629216122
Name:RUIZ, RUBEN (BA)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LAKE DR
Mailing Address - Street 2:7
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1352
Mailing Address - Country:US
Mailing Address - Phone:559-577-5746
Mailing Address - Fax:
Practice Address - Street 1:153 N U ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2438
Practice Address - Country:US
Practice Address - Phone:559-445-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor