Provider Demographics
NPI:1427262179
Name:RUIZ, JARRELYN NELSON (FAMILY & FRIENDS ORG)
Entity type:Individual
Prefix:MRS
First Name:JARRELYN
Middle Name:NELSON
Last Name:RUIZ
Suffix:
Gender:F
Credentials:FAMILY & FRIENDS ORG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41691
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-1691
Mailing Address - Country:US
Mailing Address - Phone:225-274-0069
Mailing Address - Fax:
Practice Address - Street 1:16969 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1742
Practice Address - Country:US
Practice Address - Phone:225-274-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7770001214977902Medicaid
LA7770001215061201Medicaid
LA7770001215111001Medicaid