Individual
MISS ITZAI ANDREA RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OCPSA 161734
Contact information
Practice address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
Mailing address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
405300000X
Prevention Professional
Primary
161734
OH
Other
Enumeration date
08/17/2021
Last updated
09/06/2023
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