Provider Demographics
NPI:1740756550
Name:RUIZ, NIDIA JANETH (NMD)
Entity Type:Individual
Prefix:DR
First Name:NIDIA
Middle Name:JANETH
Last Name:RUIZ
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:NIDIA
Other - Middle Name:JANETH
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12067 N 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1626
Mailing Address - Country:US
Mailing Address - Phone:480-252-1058
Mailing Address - Fax:
Practice Address - Street 1:2121 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4908
Practice Address - Country:US
Practice Address - Phone:602-241-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1739175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath