Provider Demographics
NPI:1225835994
Name:RUIZ LOPEZ, IRENARDO
Entity type:Individual
Prefix:
First Name:IRENARDO
Middle Name:
Last Name:RUIZ LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VIA TRIVOLI
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1837
Mailing Address - Country:US
Mailing Address - Phone:308-379-6868
Mailing Address - Fax:
Practice Address - Street 1:2727 W 2ND ST STE 215
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4683
Practice Address - Country:US
Practice Address - Phone:402-334-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant