Individual
MR. JOSE ANTHONY RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3623 LATROBE DR STE 216, CHARLOTTE, NC 28211-2117
(704) 332-1291
Mailing address
PO BOX 221249, CHARLOTTE, NC 28222-1249
(980) 208-1704
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001001538
NC
363A00000X
Physician Assistant
PA60528245
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-01538
NORTH CAROLINA MEDICAL BOARD
NC
01
—
0350498
L&I-RADIA REST OF WA
WA
01
—
0350499
L&I-RADIA KING COUNTY
WA
01
—
0350501
L&I-EVERGREEN RADIA
WA
01
—
0350502
L&I-SWEDISH RADIA EDMONDS
WA
05
—
2042991
—
WA
Enumeration date
07/22/2008
Last updated
07/02/2021
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