Provider Demographics
NPI:1427640218
Name:RUIZ, JEAN ANDRE MARTIN (LVN)
Entity type:Individual
Prefix:
First Name:JEAN ANDRE MARTIN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3026
Mailing Address - Country:US
Mailing Address - Phone:760-504-7864
Mailing Address - Fax:
Practice Address - Street 1:250 N ASH ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3026
Practice Address - Country:US
Practice Address - Phone:760-504-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287351164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse