Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G73238 | CA |
NPI | 1003826884 |
---|---|
Provider Name | David Ruiz |
First Address | Pismo Beach, CA 93449-3402 |
Second Address | Pismo Beach, CA 93449-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 11/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F57120 | (02) | CA |