Provider Demographics
NPI:1598078339
Name:RUIZ, ELIMAR (MSW)
Entity Type:Individual
Prefix:
First Name:ELIMAR
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 CALLE SAN ROBERTO EDIFICIO 5 SUITE 301
Mailing Address - Street 2:PROFESSIONAL OFFICE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:787-641-0073
Practice Address - Street 1:996 CALLE SAN ROBERTO EDIFICIO 5 SUITE 301
Practice Address - Street 2:PROFESSIONAL OFFICE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:787-641-0073
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10376Medicaid