Provider Demographics
NPI:1598703340
Name:RUIZ, JULIO C (MBA,BA)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:C
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MBA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11285 SW 211TH ST
Mailing Address - Street 2:201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2211
Mailing Address - Country:US
Mailing Address - Phone:786-227-5000
Mailing Address - Fax:786-441-4441
Practice Address - Street 1:11285 SW 211TH ST
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2211
Practice Address - Country:US
Practice Address - Phone:786-227-5000
Practice Address - Fax:786-441-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765671800Medicaid