Provider Demographics
NPI:1447934062
Name:RUIZ, KAMRYN RENE
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:RENE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 TURK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4345
Mailing Address - Country:US
Mailing Address - Phone:805-338-4630
Mailing Address - Fax:
Practice Address - Street 1:650 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1536
Practice Address - Country:US
Practice Address - Phone:415-995-1705
Practice Address - Fax:415-348-8860
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3049215390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program