Provider Demographics
NPI:1467043463
Name:RUIZ, MAGNELIA NICOLASA VAZQUEZ
Entity Type:Individual
Prefix:MRS
First Name:MAGNELIA NICOLASA
Middle Name:VAZQUEZ
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:PO BOX 558882
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-8882
Mailing Address - Country:US
Mailing Address - Phone:786-857-2379
Mailing Address - Fax:
Practice Address - Street 1:190 W 28TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1606
Practice Address - Country:US
Practice Address - Phone:305-885-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily