Provider Demographics
NPI:1285459552
Name:RUIZ, CARLOS FRANCISCO (CADCII A058280920)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:FRANCISCO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:CADCII A058280920
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1456
Mailing Address - Country:US
Mailing Address - Phone:714-395-0152
Mailing Address - Fax:
Practice Address - Street 1:5270 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1456
Practice Address - Country:US
Practice Address - Phone:714-395-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA058280920101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)