Individual
LISA MARIE RUIZ-GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, AT
Contact information
Practice address
1202 W THOMAS RD, PHOENIX, AZ 85013-4208
(602) 285-7239
(602) 285-7333
Mailing address
3908 E MONTEROSA ST, PHOENIX, AZ 85018-4821
(602) 296-4358
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0321
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020202228
BOCATC CERTIFICATION NUMBER
AZ
Enumeration date
12/12/2011
Last updated
12/12/2011
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