Provider Demographics
NPI:1710527411
Name:RUIZ, DAVID I (BOBBY)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUIZ
Suffix:I
Gender:M
Credentials:BOBBY
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:FELICIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CREDENTIAL
Mailing Address - Street 1:3205 OXFORD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3565
Mailing Address - Country:US
Mailing Address - Phone:917-916-7692
Mailing Address - Fax:
Practice Address - Street 1:3205 OXFORD AVE APT 10
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3565
Practice Address - Country:US
Practice Address - Phone:917-916-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY44005478171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
831163621OtherCOMPLIANCE SPECIALIST