Provider Demographics
NPI:1619021565
Name:RUIZ ACOSTA, MARILINDA
Entity Type:Individual
Prefix:DR
First Name:MARILINDA
Middle Name:
Last Name:RUIZ ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3ER SECCION
Mailing Address - Street 2:30-73 PASEO CIPRES
Mailing Address - City:LEVITOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-894-1858
Mailing Address - Fax:787-894-1858
Practice Address - Street 1:BO. ANGELES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-894-1858
Practice Address - Fax:787-894-1858
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11953208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3956OtherPMC
PR89408OtherTRIPLE S
PRP080OtherIMC
PR100111OtherMMM
PR0089408Medicare ID - Type Unspecified
3956OtherPMC