Provider Demographics
NPI:1538601067
Name:RUIZ-HOM, ELISE MEE LING
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MEE LING
Last Name:RUIZ-HOM
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 1:11700 SW BUTNER RD APT 206
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5758
Mailing Address - Country:US
Mailing Address - Phone:808-227-3488
Mailing Address - Fax:
Practice Address - Street 1:11700 SW BUTNER RD APT 206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5758
Practice Address - Country:US
Practice Address - Phone:808-227-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker