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Organization
IDAHORMONES
Active
Organization
IDAHORMONES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE RUIZ PA (OWNER)
(208) 874-2394
Entity
Organization
Contact information
Practice address
3648 N CENTREPOINT WAY STE 110, MERIDIAN, ID 83646-7626
(208) 874-2394
Mailing address
4954 W GREY TOWERS DR, MERIDIAN, ID 83642-9281
(208) 874-2394
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NULL
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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