Provider Demographics
NPI:1760945844
Name:RUIZ AMORES, DESLY JESUS (SA-C)
Entity Type:Individual
Prefix:
First Name:DESLY
Middle Name:JESUS
Last Name:RUIZ AMORES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 HIBISCUS LN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1873
Mailing Address - Country:US
Mailing Address - Phone:561-412-9349
Mailing Address - Fax:
Practice Address - Street 1:1922 HIBISCUS LN
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1873
Practice Address - Country:US
Practice Address - Phone:561-412-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19-186246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant