Provider Demographics
NPI:1679647903
Name:RUIZ VELEZ, LUZ TARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:TARINA
Last Name:RUIZ VELEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:TARINA
Other - Last Name:RUIZ VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0561
Mailing Address - Country:US
Mailing Address - Phone:787-836-1127
Mailing Address - Fax:
Practice Address - Street 1:805 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1402
Practice Address - Country:US
Practice Address - Phone:787-836-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13935208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH67173Medicare UPIN