Provider Demographics
NPI:1942449442
Name:RUBEN M RUIZ III MD INC
Entity Type:Organization
Organization Name:RUBEN M RUIZ III MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:310-408-2999
Mailing Address - Street 1:3012 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2536
Mailing Address - Country:US
Mailing Address - Phone:626-572-8692
Mailing Address - Fax:310-414-3515
Practice Address - Street 1:3012 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2536
Practice Address - Country:US
Practice Address - Phone:626-572-8692
Practice Address - Fax:310-414-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78287208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL456AMedicare PIN