1003905167 NPI number — MRS. MARIA DEL REFUGIO RIVERA RUIZ LPT

Table of content: MRS. MARIA DEL REFUGIO RIVERA RUIZ LPT (NPI 1003905167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003905167 NPI number — MRS. MARIA DEL REFUGIO RIVERA RUIZ LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ
Provider First Name:
MARIA DEL REFUGIO
Provider Middle Name:
RIVERA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUIZ
Provider Other First Name:
REFUGIO
Provider Other Middle Name:
RIVERA
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003905167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S CITRON ST APT 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92805-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-758-8146
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE # 890
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-480-6610
Provider Business Practice Location Address Fax Number:
714-480-6613
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 167G00000X , with the licence number:  22709 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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