Provider Demographics
NPI:1225610496
Name:FUENTES RUIZ, JEISY
Entity Type:Individual
Prefix:
First Name:JEISY
Middle Name:
Last Name:FUENTES 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 1:8810 SW 132ND PL APT 405
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1723
Mailing Address - Country:US
Mailing Address - Phone:786-339-2631
Mailing Address - Fax:
Practice Address - Street 1:8810 SW 132ND PL APT 405
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1723
Practice Address - Country:US
Practice Address - Phone:786-339-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator