Provider Demographics
NPI:1801137922
Name:RUIZ, VANESSA DIANE
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:DIANE
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:P.O. BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6184
Mailing Address - Country:US
Mailing Address - Phone:157-538-8447
Mailing Address - Fax:575-534-1150
Practice Address - Street 1:315 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6184
Practice Address - Country:US
Practice Address - Phone:157-538-8447
Practice Address - Fax:575-534-1150
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator