Provider Demographics
NPI:1124389978
Name:RUIZ-RODRIGUEZ, HAROLD MAURICIO (LPN)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:MAURICIO
Last Name:RUIZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 38TH ST
Mailing Address - Street 2:APT 405
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4800
Mailing Address - Country:US
Mailing Address - Phone:201-245-6597
Mailing Address - Fax:
Practice Address - Street 1:318 38TH ST
Practice Address - Street 2:APT 405
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4800
Practice Address - Country:US
Practice Address - Phone:201-245-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06404600164W00000X
NY306739164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse