Provider Demographics
NPI:1669854543
Name:RUIZ, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3468
Mailing Address - Country:US
Mailing Address - Phone:860-224-6305
Mailing Address - Fax:860-224-6349
Practice Address - Street 1:75 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3468
Practice Address - Country:US
Practice Address - Phone:860-224-6305
Practice Address - Fax:860-224-6349
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health