Provider Demographics
NPI:1114647682
Name:GONZALEZ RUIZ, JEIXA SHARELLE
Entity Type:Individual
Prefix:
First Name:JEIXA
Middle Name:SHARELLE
Last Name:GONZALEZ RUIZ
Suffix:
Gender:F
Credentials:
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 8196
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8196
Mailing Address - Country:US
Mailing Address - Phone:186-231-0708
Mailing Address - Fax:
Practice Address - Street 1:URB. AVENTURA BUZON 10 CALLE ESPERANZA
Practice Address - Street 2:B8
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:862-310-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty