Provider Demographics
NPI:1376203711
Name:RUIZ, MARIA A
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name: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 1:2233 GOLF MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7851
Mailing Address - Country:US
Mailing Address - Phone:973-558-6748
Mailing Address - Fax:
Practice Address - Street 1:975 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5044
Practice Address - Country:US
Practice Address - Phone:973-558-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist