Provider Demographics
NPI:1558083337
Name:RUIZ LINARES, ALEXIS (CBHCM)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:RUIZ LINARES
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10907 SW 88TH ST APT 423
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1276
Mailing Address - Country:US
Mailing Address - Phone:512-770-5606
Mailing Address - Fax:
Practice Address - Street 1:640 W PALM DR STE D
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3237
Practice Address - Country:US
Practice Address - Phone:786-601-7757
Practice Address - Fax:786-601-7758
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0104285171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM.0104285Medicaid