Provider Demographics
NPI:1265908891
Name:RUIZ, IVETTE
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4722
Mailing Address - Country:US
Mailing Address - Phone:203-907-9535
Mailing Address - Fax:
Practice Address - Street 1:27 GEORGE ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-4722
Practice Address - Country:US
Practice Address - Phone:203-907-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171W00000XOther Service ProvidersContractor
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner