Provider Demographics
NPI:1073637310
Name:VERA RUIZ FAMILY MEDICINE, CSP.
Entity Type:Organization
Organization Name:VERA RUIZ FAMILY MEDICINE, CSP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:IX
Authorized Official - Credentials:MD
Authorized Official - Phone:787-818-1266
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-818-1266
Mailing Address - Fax:787-877-3813
Practice Address - Street 1:CARRETERA 111 KM 3.0 INTERIOR 125
Practice Address - Street 2:BO PUEBLO SECTOR ACEVEDO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-1266
Practice Address - Fax:787-877-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13490302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization