Provider Demographics
NPI:1265097919
Name:RUIZ, TRINIDAD YSIDRO
Entity type:Individual
Prefix:
First Name:TRINIDAD
Middle Name:YSIDRO
Last Name:RUIZ
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 1:1186 DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4201
Mailing Address - Country:US
Mailing Address - Phone:720-480-0386
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2041
Practice Address - Country:US
Practice Address - Phone:855-838-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health