Provider Demographics
NPI:1457329484
Name:RUIZ, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:RUIZ
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:PO BOX 142378
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2378
Mailing Address - Country:US
Mailing Address - Phone:787-317-2305
Mailing Address - Fax:787-817-7181
Practice Address - Street 1:860 AVE MIRAMAR
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2724
Practice Address - Country:US
Practice Address - Phone:787-317-2305
Practice Address - Fax:787-881-7181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87996RUOtherTRIPLE-S
PR87960Medicare ID - Type Unspecified
PRG43030Medicare UPIN