Provider Demographics
NPI:1487799219
Name:RUIZ, JOE LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:LUIS
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 1:9615 BRIGHTON WAY
Mailing Address - Street 2:SUITE 332
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5131
Mailing Address - Country:US
Mailing Address - Phone:310-271-9177
Mailing Address - Fax:
Practice Address - Street 1:9615 BRIGHTON WAY
Practice Address - Street 2:SUITE 332
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5131
Practice Address - Country:US
Practice Address - Phone:310-271-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45206Medicare UPIN