Provider Demographics
NPI:1447687041
Name:RUIZ, RAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W HIGH ST UNIT 813
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93020-7048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8616 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4014
Practice Address - Country:US
Practice Address - Phone:520-244-0009
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14713363A00000X
WAPA61378206363A00000X
GA11771363A00000X
MAPA101043363A00000X
TXPA17903363A00000X
CAPA23251363A00000X
COPA.0007645363A00000X
AZ8912363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant