Provider Demographics
NPI:1447783246
Name:RUIZ SANTIAGO, MAYTE SOLANGE (MD)
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:SOLANGE
Last Name:RUIZ SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5750 COLLINS AVE
Mailing Address - Street 2:APT 14G
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2313
Mailing Address - Country:US
Mailing Address - Phone:305-200-7681
Mailing Address - Fax:786-558-5984
Practice Address - Street 1:900 W 49TH ST STE 502
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3488
Practice Address - Country:US
Practice Address - Phone:786-618-5182
Practice Address - Fax:567-345-6138
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1442322084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty