Individual
KELLY RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
21 GRAND ST, HARTFORD, CT 06106-1541
(860) 550-7500
Mailing address
7 KENT LN, BLOOMFIELD, CT 06002-1326
(860) 713-9655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1163512
CT
Other
Enumeration date
06/09/2019
Last updated
06/09/2019
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