Provider Demographics
NPI:1083846893
Name:RUIZ IRIZARRY, YELLIANN (MD)
Entity Type:Individual
Prefix:
First Name:YELLIANN
Middle Name:
Last Name:RUIZ IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 SW 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6239
Mailing Address - Country:US
Mailing Address - Phone:787-415-9639
Mailing Address - Fax:305-901-6899
Practice Address - Street 1:9299 SW 152ND ST STE 205
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1776
Practice Address - Country:US
Practice Address - Phone:305-901-6890
Practice Address - Fax:305-901-6899
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1102X
PR176241744R1102X, 207RR0500X
FL124445207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083846893OtherNPI