Provider Demographics
NPI:1114218138
Name:PATEL EGUSQUIZA, RUCHI (MD)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:PATEL EGUSQUIZA
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 1:14261 SW 120TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7273
Mailing Address - Country:US
Mailing Address - Phone:305-378-1302
Mailing Address - Fax:305-383-5314
Practice Address - Street 1:14261 SW 120TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7273
Practice Address - Country:US
Practice Address - Phone:305-378-1302
Practice Address - Fax:305-383-5314
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134557207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100106300Medicaid