Provider Demographics
NPI:1124840491
Name:RUIZ JR, DOMINGO JR (BS, MADR, PSYM, MFT)
Entity type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:
Last Name:RUIZ JR
Suffix:JR
Gender:M
Credentials:BS, MADR, PSYM, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22002 FLASHING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1472
Mailing Address - Country:US
Mailing Address - Phone:281-881-9160
Mailing Address - Fax:
Practice Address - Street 1:20008 CHAMPION FOREST DR STE 601
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8696
Practice Address - Country:US
Practice Address - Phone:281-939-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty