Provider Demographics
NPI:1750485330
Name:RUIZ, PATRICIA (MS, SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2060
Mailing Address - Country:US
Mailing Address - Phone:786-541-7289
Mailing Address - Fax:
Practice Address - Street 1:717 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2060
Practice Address - Country:US
Practice Address - Phone:786-541-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5012235Z00000X
104100000X, 222Q00000X
AZ6237235Z00000X
FLSA11107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767599200Medicaid
FL002847200Medicaid
FL811854000Medicaid