Provider Demographics
NPI:1902179542
Name:RUIZ, ADRIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 E COALINGA DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-9109
Mailing Address - Country:US
Mailing Address - Phone:650-438-7344
Mailing Address - Fax:
Practice Address - Street 1:3086 E COALINGA DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-9109
Practice Address - Country:US
Practice Address - Phone:650-438-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist