Provider Demographics
NPI:1558457762
Name:RUIZ GARCIA, WILLIAM M
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:RUIZ GARCIA
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 1:1353 AVE LUIS VIGOREAUX GARDEN HILLS PLAZA
Mailing Address - Street 2:SUITE 333
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-782-7816
Practice Address - Fax:787-782-7816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD99583Medicare UPIN
PR28286Medicare ID - Type Unspecified