Provider Demographics
NPI:1730712449
Name:RUIZ, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
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 1:6991 ELLICOTT CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2760
Mailing Address - Country:US
Mailing Address - Phone:619-379-4260
Mailing Address - Fax:
Practice Address - Street 1:6991 ELLICOTT CT
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2760
Practice Address - Country:US
Practice Address - Phone:619-379-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician