Provider Demographics
NPI:1770156606
Name:RUIZ, JOANNA ROXANA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ROXANA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ROXANA
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:906 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2610
Mailing Address - Country:US
Mailing Address - Phone:915-613-3033
Mailing Address - Fax:915-613-3030
Practice Address - Street 1:AVENIDA JUAREZ 3783
Practice Address - Street 2:
Practice Address - City:CIUDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32000
Practice Address - Country:MX
Practice Address - Phone:915-613-3030
Practice Address - Fax:915-613-3030
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48657781223G0001X
ZZ4865778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice