Provider Demographics
NPI:1598976557
Name:RUIZ CORDERO, SANTOS (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOS
Middle Name:
Last Name:RUIZ CORDERO
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 1:1485 37TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6518
Mailing Address - Country:US
Mailing Address - Phone:772-584-3114
Mailing Address - Fax:772-567-4340
Practice Address - Street 1:1485 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6518
Practice Address - Country:US
Practice Address - Phone:725-843-1147
Practice Address - Fax:772-567-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN501311Z00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107787600Medicaid