| Edward A. Ruiz Md, Professional Corporation | |
|
47110 Washington St Ste 203 La Quinta CA 92253-2186 | |
| (760) 564-9205 | |
| (760) 771-6243 |
| Full Name | Edward A. Ruiz Md, Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 47110 Washington St Ste 203, La Quinta, California |
| Authorized Official Name and Position | Edward Andrew Ruiz (OWNER) |
| Authorized Official Contact | 7605649205 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward A. Ruiz Md, Professional Corporation 47110 Washington St Ste 203 La Quinta CA 92253-2186 Ph: (760) 564-9205 | Edward A. Ruiz Md, Professional Corporation 47110 Washington St Ste 203 La Quinta CA 92253-2186 Ph: (760) 564-9205 |
| NPI Number | 1003072620 |
|---|---|
| Provider Enumeration Date | 08/03/2008 |
| Last Update Date | 01/19/2016 |
| Medicare PECOS PAC ID | 6305908872 |
|---|---|
| Medicare Enrollment ID | O20081217000161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003072620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | A104554 (California) | Primary |
| Provider Name | Edward A Ruiz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598961708 PECOS PAC ID: 6002909561 Enrollment ID: I20081217000147 |
| Provider Name | Jeanne M Perafan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831377829 PECOS PAC ID: 1052462009 Enrollment ID: I20090702000208 |
| Provider Name | Estela C Dorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184285439 PECOS PAC ID: 5193188027 Enrollment ID: I20230825000534 |
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