Provider Demographics
NPI:1508646597
Name:RUIZ CHANG, ALBERTO ENRIQUE (RNFA)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:ENRIQUE
Last Name:RUIZ CHANG
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16609 SW 79TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5776
Mailing Address - Country:US
Mailing Address - Phone:786-665-1305
Mailing Address - Fax:
Practice Address - Street 1:16609 SW 79TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5776
Practice Address - Country:US
Practice Address - Phone:786-665-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-456246ZC0007X
FLRN9584400163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant