Individual
MR. ANTONIO MARIANO RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2817 REILLY ROAD, FORT BRAGG, NC 28307
(210) 267-7793
Mailing address
6910 SURREY RD, FAYETTEVILLE, NC 28306-2553
(210) 267-7793
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
001005216
NC
Other
Enumeration date
12/02/2013
Last updated
12/10/2018
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