Provider Demographics
NPI:1821089129
Name:RUIZ, RAHEL TEFERI
Entity Type:Individual
Prefix:DR
First Name:RAHEL
Middle Name:TEFERI
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3125
Mailing Address - Country:US
Mailing Address - Phone:510-271-4400
Mailing Address - Fax:
Practice Address - Street 1:18675 BUREN PL
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5281
Practice Address - Country:US
Practice Address - Phone:510-881-2192
Practice Address - Fax:510-363-8642
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17867Medicare UPIN
00A643040Medicare ID - Type Unspecified