Provider Demographics
NPI:1861627200
Name:RUIZ, JOSE IGNACIO (LAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4978 SANTA ANITA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3600
Mailing Address - Country:US
Mailing Address - Phone:626-575-3919
Mailing Address - Fax:626-575-6270
Practice Address - Street 1:4978 SANTA ANITA AVE STE 205
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-3600
Practice Address - Country:US
Practice Address - Phone:626-575-3919
Practice Address - Fax:626-575-6270
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4176171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist