Provider Demographics
NPI:1134099328
Name:RUIZ TOSCANO, MARTHA A
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:RUIZ TOSCANO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15431 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-7709
Mailing Address - Country:US
Mailing Address - Phone:313-704-7761
Mailing Address - Fax:
Practice Address - Street 1:15431 COOPER ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-7709
Practice Address - Country:US
Practice Address - Phone:313-704-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR232585071724172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker