Provider Demographics
NPI:1437235025
Name:RUIZ ORTIZ, JOSE (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:RUIZ ORTIZ
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:CALLE JOSE HENNA 7925
Mailing Address - Street 2:URBANIZACION MARIANI
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0214
Mailing Address - Country:US
Mailing Address - Phone:787-244-5034
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE HENNA 7925
Practice Address - Street 2:URBANIZACION MARIANI
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0214
Practice Address - Country:US
Practice Address - Phone:787-244-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12671208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
21388RUOtherSSS
H80193Medicare UPIN
0021388Medicare ID - Type Unspecified