Provider Demographics
NPI:1063476745
Name:ACOSTA-RUIZ, MELVYN SR (MD)
Entity Type:Individual
Prefix:
First Name:MELVYN
Middle Name:
Last Name:ACOSTA-RUIZ
Suffix:SR
Gender:M
Credentials:MD
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 1907
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1907
Mailing Address - Country:US
Mailing Address - Phone:787-878-3304
Mailing Address - Fax:787-878-3304
Practice Address - Street 1:53 CALLE DOMINGO RUBIO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4433
Practice Address - Country:US
Practice Address - Phone:787-878-3304
Practice Address - Fax:787-878-3304
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC83670Medicare UPIN
PR0092517Medicare PIN