Provider Demographics
NPI:1215191184
Name:RUIZ, ERICA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MICHELLE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47110 WASHINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2186
Mailing Address - Country:US
Mailing Address - Phone:760-564-9205
Mailing Address - Fax:760-771-6243
Practice Address - Street 1:47110 WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2186
Practice Address - Country:US
Practice Address - Phone:760-564-9205
Practice Address - Fax:760-771-6243
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA542Medicare PIN