Provider Demographics
NPI:1992751622
Name:RUIZ-HEALY, JOSEPHINE (MD)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:RUIZ-HEALY
Suffix:
Gender:F
Credentials:MD
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 2277
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2277
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:210-558-6289
Practice Address - Street 1:4115 MEDICAL DR STE 305
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5636
Practice Address - Country:US
Practice Address - Phone:210-615-8272
Practice Address - Fax:210-692-9455
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136255011OtherMEDICAID EP1
TX136255010Medicaid
TX136255010Medicaid