Provider Demographics
NPI:1710173471
Name:RUIZ, JUVENTINO JR (OTR)
Entity Type:Individual
Prefix:
First Name:JUVENTINO
Middle Name:
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 VIDA SANTA ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2014
Mailing Address - Country:US
Mailing Address - Phone:956-533-4390
Mailing Address - Fax:956-683-6448
Practice Address - Street 1:5215 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2202
Practice Address - Country:US
Practice Address - Phone:956-803-0033
Practice Address - Fax:956-683-6448
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist