Roberto Carrillo Ruiz, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT.003568 Issued in OH

Practice address

4200 N Pebble Creek Pkwy Apt 2090
Goodyear, AZ 85395-9032

Phone

(216) 973-7794

NPI assigned

May 20, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1053723494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 N PEBBLE CREEK PKWY APT 2090",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959032",
            "telephone_number": "216-973-7794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 N PEBBLE CREEK PKWY APT 2090",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959032",
            "telephone_number": "216-973-7794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "ROBERTO",
        "middle_name": "CARRILLO",
        "name_prefix": "Mr.",
        "credential": "LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-20",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1012",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT.003568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Royster, MS, OTRL
• Katherine Theresa Ruddy, PA-C
• Grace Mary Ruettinger, PA
• Kaitlyn Ruff, SLPA
• Pablo Ruiz Jr., P.T.
• David Frank Rusick, D.C.
• Andrew Kaiwon Russell Cheung
• Anthony Theodore Russell
• Kathryn Rutherford, PT, DPT
• RWW Outpatient Rehab Services, LLC

• Athletic Trainer in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.