Provider Demographics
NPI:1659334415
Name:SOSTRE-RUIZ, NYDIA (DR)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:
Last Name:SOSTRE-RUIZ
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB #377 PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-282-8217
Mailing Address - Fax:787-282-8217
Practice Address - Street 1:PLAZA SAN FRANCISCO, SUITE 107
Practice Address - Street 2:AVE. DE DIEGO # 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5931
Practice Address - Country:US
Practice Address - Phone:787-282-0741
Practice Address - Fax:787-282-8217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15-192OtherPSYCHOLOGIST
PR008-7657Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
PR2165Medicare UPIN
PR55455SOMedicare UPIN