Provider Demographics
NPI:1982613253
Name:RUIZ, GONZALO FLORES (MD)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:FLORES
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 1:22741 LAMBERT ST
Mailing Address - Street 2:SUITE1607
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1617
Mailing Address - Country:US
Mailing Address - Phone:949-581-3011
Mailing Address - Fax:949-581-6457
Practice Address - Street 1:22741 LAMBERT ST
Practice Address - Street 2:SUITE1607
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1617
Practice Address - Country:US
Practice Address - Phone:949-581-3011
Practice Address - Fax:949-581-6457
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75692207Q00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine