Provider Demographics
NPI:1346058658
Name:DE ALBA RUIZ, IGNACIO N (PTA)
Entity type:Individual
Prefix:
First Name:IGNACIO
Middle Name:N
Last Name:DE ALBA RUIZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16409 E GOODFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9583
Mailing Address - Country:US
Mailing Address - Phone:559-374-4202
Mailing Address - Fax:
Practice Address - Street 1:1132 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-3195
Practice Address - Country:US
Practice Address - Phone:559-876-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52727225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant