Provider Demographics
NPI:1780297200
Name:RUIZ, EVITHNER MENDOZA
Entity type:Individual
Prefix:MRS
First Name:EVITHNER
Middle Name:MENDOZA
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 1:9100 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-1337
Mailing Address - Country:US
Mailing Address - Phone:858-956-4016
Mailing Address - Fax:
Practice Address - Street 1:9100 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-1337
Practice Address - Country:US
Practice Address - Phone:858-956-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX964248163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse