Provider Demographics
NPI:1154815892
Name:RUIZ, LIZETTE
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:RUIZ
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 1:11908 ANDERSON MILL RD APT 817
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1127
Mailing Address - Country:US
Mailing Address - Phone:832-374-2282
Mailing Address - Fax:
Practice Address - Street 1:11908 ANDERSON MILL RD APT 817
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1127
Practice Address - Country:US
Practice Address - Phone:832-374-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician