Provider Demographics
NPI:1912901471
Name:RUIZ, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4735
Mailing Address - Country:US
Mailing Address - Phone:323-712-4811
Mailing Address - Fax:323-544-6488
Practice Address - Street 1:436 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-877-8868
Practice Address - Fax:909-877-0008
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG052245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060100Medicaid
CAGR0060102Medicaid
CAGR0060101Medicaid
CAW13542Medicare ID - Type UnspecifiedMEDICAL GROUP PRACTICE
CAZZZ21965ZMedicare ID - Type UnspecifiedMEDICAL GROUP PRACTICE
CAZZZ00438ZMedicare ID - Type UnspecifiedMEDICAL GROUP PRACTICE
CAGR0060100Medicaid