Provider Demographics
NPI:1245954692
Name:RUIZ MUNOZ, LESLIE JACQUELINE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JACQUELINE
Last Name:RUIZ MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JACQUELINE
Other - Last Name:RUIZ MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20995 MURAL ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-9366
Mailing Address - Country:US
Mailing Address - Phone:951-423-1649
Mailing Address - Fax:
Practice Address - Street 1:20995 MURAL ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-9366
Practice Address - Country:US
Practice Address - Phone:951-423-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician