Provider Demographics
NPI:1336890524
Name:RUIZ, JORGE RAUL (MPH, LVN)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:RAUL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MPH, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DESERT CHIEF DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4178
Mailing Address - Country:US
Mailing Address - Phone:956-789-3749
Mailing Address - Fax:
Practice Address - Street 1:402 E HILLSIDE RD STE 5
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3292
Practice Address - Country:US
Practice Address - Phone:956-789-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157594164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse