Basic Information
| Provider Information | |||||||||
| NPI: | 1972569721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ-NAZARIO | ||||||||
| FirstName: | JAVIER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUIZ | ||||||||
| OtherFirstName: | JAVIER | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17207 KUYKENDAHL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773798423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813748555 | ||||||||
| FaxNumber: | 2813748335 | ||||||||
| Practice Location | |||||||||
| Address1: | 17207 KUYKENDAHL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773798423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813748555 | ||||||||
| FaxNumber: | 2813748335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | H7036 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | H7036 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 80190G | 01 | TX | BC/BS NUMBER | OTHER |