Provider Demographics
NPI:1720183676
Name:GUTIERREZ RUIZ MD PA
Entity Type:Organization
Organization Name:GUTIERREZ RUIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-828-9100
Mailing Address - Street 1:1949 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4403
Mailing Address - Country:US
Mailing Address - Phone:305-828-9100
Mailing Address - Fax:305-828-5553
Practice Address - Street 1:1949 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4403
Practice Address - Country:US
Practice Address - Phone:305-828-9100
Practice Address - Fax:305-828-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92976174400000X
FLME92389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274010900Medicaid
FL274010900Medicaid