Individual
MR. IAN LLOYD RUIZ BACCAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5263 S HIGHWAY 95 , FORT MOHAVE, AZ 86426, FORT MOHAVE, AZ 86426-9223
(928) 704-6400
Mailing address
4425 S BERNARD PL, FORT MOHAVE, AZ 86426-5388
(928) 299-1268
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
295726
AZ
363LF0000X
Family Nurse Practitioner
100460
GU
Other
Enumeration date
07/31/2023
Last updated
06/12/2025
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