Provider Demographics
NPI:1972001329
Name:RUIZ, MARION FIDES
Entity Type:Individual
Prefix:MISS
First Name:MARION FIDES
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARION FIDES
Other - Middle Name:C
Other - Last Name:VALLINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5839 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5445
Mailing Address - Country:US
Mailing Address - Phone:872-600-1689
Mailing Address - Fax:
Practice Address - Street 1:5839 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5445
Practice Address - Country:US
Practice Address - Phone:872-600-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019354225X00000X
IL056011354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist