Provider Demographics
NPI:1902343270
Name:RUIZ, JOSE ARMANDO
Entity type:Individual
Prefix:
First Name:JOSE ARMANDO
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
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 495
Mailing Address - Street 2:
Mailing Address - City:ALVISO
Mailing Address - State:CA
Mailing Address - Zip Code:95002-0495
Mailing Address - Country:US
Mailing Address - Phone:408-903-5008
Mailing Address - Fax:
Practice Address - Street 1:1401 PARKMOOR AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-971-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor