Provider Demographics
NPI:1841534971
Name:RUIZ COFFELT, MARTHA I (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:RUIZ COFFELT
Suffix:I
Gender:F
Credentials:RDHAP
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:DEL CARMEN
Other - Last Name:RUIZ COFFELT
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RDHAP
Mailing Address - Street 1:1499 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8245
Mailing Address - Country:US
Mailing Address - Phone:916-223-0139
Mailing Address - Fax:
Practice Address - Street 1:1499 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8245
Practice Address - Country:US
Practice Address - Phone:916-223-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist