Organization
R RUIZ M D A MEDICAL CORP
Active
Other names
Rialto Clinica Medica Familiar
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN RUIZ MD (LABORATORY DIRECTOR)
(562) 201-2508
Entity
Organization
Contact information
Practice address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Mailing address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLA 328915
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0994683
CLIA CERTIFICATE OF WAIVER
CA
01
—
CLA 328915
CLINICAL LABORATORY LICENSE
CA
Enumeration date
12/16/2010
Last updated
05/25/2023
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