Provider Demographics
NPI:1861617185
Name:RUIZ, VICENTE (CDP)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FORREST RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9758
Mailing Address - Country:US
Mailing Address - Phone:509-882-3992
Mailing Address - Fax:
Practice Address - Street 1:1313 W WINE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1043
Practice Address - Country:US
Practice Address - Phone:509-882-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005549101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)