Provider Demographics
NPI:1720147077
Name:RUIZ, ROBERT W (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PA
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 11179
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1179
Mailing Address - Country:US
Mailing Address - Phone:888-517-2788
Mailing Address - Fax:562-468-0347
Practice Address - Street 1:1415 ROSS AVENUE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:99243-4306
Practice Address - Country:US
Practice Address - Phone:619-660-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15696207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15696Medicaid
CA1720147077Medicaid
CAPA15696Medicaid
Q16798Medicare UPIN
CAWPA15696AMedicare PIN