Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1033504337 |
---|---|
Provider Name | Alexander Ruiz |
First Address | El Centro, CA 92243-2302 |
Second Address | El Centro, CA 92243-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 23/10/2017 |