Provider Demographics
NPI:1194998237
Name:RUIZ, MARGARITA (PA-C, MS)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2939
Mailing Address - Country:US
Mailing Address - Phone:773-278-7024
Mailing Address - Fax:773-278-6948
Practice Address - Street 1:2359 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2939
Practice Address - Country:US
Practice Address - Phone:773-278-7024
Practice Address - Fax:773-278-6948
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant