Provider Demographics
NPI:1023093754
Name:RUIZ, SAMADHY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAMADHY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 INTERIOR CALLE BUENA VISTA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-209-5455
Mailing Address - Fax:
Practice Address - Street 1:5750 W. THUNDERBIRD AVE
Practice Address - Street 2:SUITE B- 200
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-375-1700
Practice Address - Fax:602-843-2847
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z2614OtherHEALTHNET
AZF05992OtherPACIFICARE
AZ959497Medicaid