Provider Demographics
NPI:1720744162
Name:RUIZ, MONA LISA (FNP)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:LISA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MONALISA
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-8517
Mailing Address - Country:US
Mailing Address - Phone:760-352-2257
Mailing Address - Fax:760-352-4579
Practice Address - Street 1:852 E DANENBERG DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-8517
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:760-352-4579
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily