Provider Demographics
NPI:1891496642
Name:QUIROZ, RUBEN RAY
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:RAY
Last Name:QUIROZ
Suffix:
Gender:M
Credentials:
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 724
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0724
Mailing Address - Country:US
Mailing Address - Phone:909-262-9952
Mailing Address - Fax:
Practice Address - Street 1:2130 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4628
Practice Address - Country:US
Practice Address - Phone:909-862-4678
Practice Address - Fax:909-862-0517
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH190687183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician