Provider Demographics
NPI:1235988254
Name:RUIZ, BRYAN XAVIER
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:XAVIER
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1409
Mailing Address - Country:US
Mailing Address - Phone:702-942-1774
Mailing Address - Fax:
Practice Address - Street 1:850 MILL ST STE 301
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1484
Practice Address - Country:US
Practice Address - Phone:775-562-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst