Provider Demographics
NPI:1689862039
Name:MORALES-RUZ, QUEENLAND (MD)
Entity Type:Individual
Prefix:MRS
First Name:QUEENLAND
Middle Name:
Last Name:MORALES-RUZ
Suffix:
Gender:F
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:PO BOX 1485
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1485
Mailing Address - Country:US
Mailing Address - Phone:787-448-7328
Mailing Address - Fax:
Practice Address - Street 1:MARLIN AZUL #14
Practice Address - Street 2:SAN DEMETRIO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD83341Medicare UPIN