Provider Demographics
NPI:1598755761
Name:RUIZ-SANTIAGO, GUSTAVO V (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:V
Last Name:RUIZ-SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 WINEGARD RD, 2ND FLOOR STE 9
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7147
Mailing Address - Country:US
Mailing Address - Phone:407-930-0050
Mailing Address - Fax:407-751-4804
Practice Address - Street 1:7726 WINEGARD RD, 2ND FLOOR STE 9
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:407-930-0050
Practice Address - Fax:407-751-4804
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME1368352084P0800X
FLACN7892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017702600Medicaid
FLACN789OtherLICENSE