Provider Demographics
NPI:1871506725
Name:RUIZ, CARMEN A (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
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:PO BOX 5018
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-5018
Mailing Address - Country:US
Mailing Address - Phone:605-454-0104
Mailing Address - Fax:605-867-3306
Practice Address - Street 1:EAST HIGHWAY 18
Practice Address - Street 2:PINE RIDGE INDIAN HOSPITAL
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-5131
Practice Address - Fax:605-867-3306
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics