Provider Demographics
NPI:1073070868
Name:BARRERA RUIZ, JOSE ALEJANDRO (SA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:BARRERA RUIZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 SW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4839
Mailing Address - Country:US
Mailing Address - Phone:602-812-1828
Mailing Address - Fax:
Practice Address - Street 1:11660 SW 13TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4839
Practice Address - Country:US
Practice Address - Phone:602-812-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18-552246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant