Provider Demographics
NPI:1477605103
Name:RUIZ, RAFAEL EDUARDO
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN RAFAEL ST. URB. VILLAS DEL PILAR
Mailing Address - Street 2:C-13
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735
Mailing Address - Country:US
Mailing Address - Phone:787-874-2652
Mailing Address - Fax:
Practice Address - Street 1:STREET E URB . MONTE BRISAS
Practice Address - Street 2:A-1
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-409-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist