Provider Demographics
NPI:1720179989
Name:RUIZ, ANGELICA MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:MENDOZA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 STORY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3942
Mailing Address - Country:US
Mailing Address - Phone:408-929-5439
Mailing Address - Fax:408-929-5010
Practice Address - Street 1:2880 STORY RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3942
Practice Address - Country:US
Practice Address - Phone:408-929-5439
Practice Address - Fax:408-929-5010
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics