Provider Demographics
NPI:1235747247
Name:RUIZ, YORDANIS SR (YR)
Entity Type:Individual
Prefix:DR
First Name:YORDANIS
Middle Name:
Last Name:RUIZ
Suffix:SR
Gender:M
Credentials:YR
Other - Prefix:DR
Other - First Name:YORDANIS
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:YORDANIS RUIZ
Mailing Address - Street 1:9304 SW 166TH TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3427
Mailing Address - Country:US
Mailing Address - Phone:305-985-9123
Mailing Address - Fax:
Practice Address - Street 1:9304 SW 166TH TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-3427
Practice Address - Country:US
Practice Address - Phone:305-985-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-127778106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-127778Medicaid
FLBACB596442OtherREGISTERD BEHAVIOR TECHNICIAN
FLBACB596442Medicaid