Provider Demographics
NPI:1033212378
Name:RUIZ ROMAN, JORGE E
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:RUIZ ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194000
Mailing Address - Street 2:PMB 409
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4000
Mailing Address - Country:US
Mailing Address - Phone:787-775-2545
Mailing Address - Fax:787-793-0835
Practice Address - Street 1:U3 #5 CALLE 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-775-2545
Practice Address - Fax:787-793-0835
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10805207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87945Medicare ID - Type Unspecified