Provider Demographics
NPI:1962608778
Name:RUIZ, GLORIA ALICIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ALICIA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ALICIA
Other - Last Name:CERCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:210-274-3137
Mailing Address - Fax:830-331-9143
Practice Address - Street 1:2105 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-3920
Practice Address - Country:US
Practice Address - Phone:210-274-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies