Provider Demographics
NPI:1275633984
Name:LASALLE-RUIZ, CONFESOR (MD)
Entity Type:Individual
Prefix:DR
First Name:CONFESOR
Middle Name:
Last Name:LASALLE-RUIZ
Suffix:
Gender:M
Credentials:MD
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 976
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0976
Mailing Address - Country:US
Mailing Address - Phone:787-896-7000
Mailing Address - Fax:787-896-7100
Practice Address - Street 1:66 CALLE MJ CABRERO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2219
Practice Address - Country:US
Practice Address - Phone:787-896-7000
Practice Address - Fax:787-896-7100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7172207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77561Medicare UPIN
PR0027692Medicare ID - Type Unspecified