Provider Demographics
NPI:1326317736
Name:RUIZ, JUANA I (MS)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:I
Last Name:RUIZ
Suffix:
Gender:F
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:AVE. CORAZONES 1040
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ,
Mailing Address - State:P.R.
Mailing Address - Zip Code:00680
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. CORAZONES 1040
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ,
Practice Address - State:P.R.
Practice Address - Zip Code:00680
Practice Address - Country:UM
Practice Address - Phone:1787-833-8700
Practice Address - Fax:1787-265-5155
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical