Provider Demographics
NPI:1346846441
Name:RAVENNA RUIZ, TERRY MARILYN (SA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MARILYN
Last Name:RAVENNA RUIZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 CASON COVE DR APT 1504
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6356
Mailing Address - Country:US
Mailing Address - Phone:321-947-2904
Mailing Address - Fax:
Practice Address - Street 1:4719 CASON COVE DR APT 1504
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-6356
Practice Address - Country:US
Practice Address - Phone:321-947-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-464246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant