Provider Demographics
NPI:1649390196
Name:RUIZ, MICHELLE DEANN I (HS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DEANN
Last Name:RUIZ
Suffix:I
Gender:F
Credentials:HS
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:DEANN
Other - Last Name:JENS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:HS
Mailing Address - Street 1:19018 STILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3338
Mailing Address - Country:US
Mailing Address - Phone:661-312-9846
Mailing Address - Fax:
Practice Address - Street 1:21545 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2947
Practice Address - Country:US
Practice Address - Phone:661-259-9439
Practice Address - Fax:661-259-9658
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9381225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner