Provider Demographics
NPI:1508804766
Name:RUIZ, CARLOS HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:HERIBERTO
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 1:425 W COLONIAL DR STE 302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:407-601-1370
Mailing Address - Fax:
Practice Address - Street 1:425 W COLONIAL DR STE 302
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6863
Practice Address - Country:US
Practice Address - Phone:407-601-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME803162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260049118OtherRAILROAD MEDICARE
FLQP199OtherHFMG MA
FL261229100Medicaid
FL03717OtherBCBS
FLE5549YMedicare PIN