Provider Demographics
NPI:1386183846
Name:RUIZ, MAYRA I
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:I
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 1:15351 SW 73RD TERRACE CIR
Mailing Address - Street 2:APT 5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15351 SW 73RD TERRACE CIR
Practice Address - Street 2:APT 5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1684
Practice Address - Country:US
Practice Address - Phone:786-728-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician