Provider Demographics
NPI:1780864991
Name:JOSE LUIS RUIZ MD PA
Entity Type:Organization
Organization Name:JOSE LUIS RUIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-971-6883
Mailing Address - Street 1:11285 SW 211TH ST
Mailing Address - Street 2:STE 304
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2211
Mailing Address - Country:US
Mailing Address - Phone:305-971-6883
Mailing Address - Fax:305-971-6836
Practice Address - Street 1:11285 SW 211TH ST
Practice Address - Street 2:STE 304
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2211
Practice Address - Country:US
Practice Address - Phone:305-971-6883
Practice Address - Fax:305-971-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME066055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373801903Medicaid
FLK7468Medicare PIN