Basic Information
| Provider Information | |||||||||
| NPI: | 1649390196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DEANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | H.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JENS | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | DEANN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | I | ||||||||
| OtherCredential: | H.S. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19018 STILLMORE ST | ||||||||
| Address2: | |||||||||
| City: | CANYON COUNTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913513338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613129846 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21545 CENTRE POINTE PKWY | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913502947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612599439 | ||||||||
| FaxNumber: | 6612599658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | 9381 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.