Provider Demographics
NPI:1639237886
Name:RUIZ, GUSTAVO ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ENRIQUE
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 WILSHIRE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6104
Mailing Address - Country:US
Mailing Address - Phone:310-271-9880
Mailing Address - Fax:310-271-8110
Practice Address - Street 1:9301 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6104
Practice Address - Country:US
Practice Address - Phone:310-271-9880
Practice Address - Fax:310-271-8110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA685192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry