Provider Demographics
NPI:1821898677
Name:RUIZ, NATHAN ANDREW
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANDREW
Last Name:RUIZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-4026
Mailing Address - Country:US
Mailing Address - Phone:323-423-2689
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2816 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4026
Practice Address - Country:US
Practice Address - Phone:323-423-2689
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst