Provider Demographics
NPI:1619378072
Name:RUIZ GLASS, NORMA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:RUIZ GLASS
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 1:1561 W FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3011
Mailing Address - Country:US
Mailing Address - Phone:954-478-7615
Mailing Address - Fax:
Practice Address - Street 1:1561 W FAIRWAY RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3011
Practice Address - Country:US
Practice Address - Phone:954-478-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)