Provider Demographics
NPI:1649475104
Name:RUIZ, NANCI JANE (LPT)
Entity type:Individual
Prefix:MS
First Name:NANCI
Middle Name:JANE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:93451-0141
Mailing Address - Country:US
Mailing Address - Phone:805-467-3237
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-781-4700
Practice Address - Fax:805-781-1232
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23749167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT23749OtherLPT