Provider Demographics
NPI:1790668077
Name:RUIZ, STEPHIE (ESTHETICIAN)
Entity type:Individual
Prefix:
First Name:STEPHIE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E SUNRISE HWY STE 153
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3943
Mailing Address - Country:US
Mailing Address - Phone:909-681-1221
Mailing Address - Fax:
Practice Address - Street 1:210 E SUNRISE HWY STE 153
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3943
Practice Address - Country:US
Practice Address - Phone:909-681-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAE-18-02664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist