Provider Demographics
NPI:1124594726
Name:RUIZ, EDNIE JAFFED SR (MS)
Entity Type:Individual
Prefix:MR
First Name:EDNIE
Middle Name:JAFFED
Last Name:RUIZ
Suffix:SR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 15262
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9268
Mailing Address - Country:US
Mailing Address - Phone:787-624-9258
Mailing Address - Fax:
Practice Address - Street 1:BO. JAGUEY CARR 411 KM 4.9
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0060
Practice Address - Country:US
Practice Address - Phone:787-624-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty