Provider Demographics
NPI:1568664712
Name:RUIZ, CARLOS IVAN (PH D (C))
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:IVAN
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PH D (C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0243
Mailing Address - Country:US
Mailing Address - Phone:787-826-6302
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO CENTRO DEL OESTE OFICINA #104
Practice Address - Street 2:BO. COLOMBIA CALLE RELAMPAGO #70
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2090103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling