Provider Demographics
NPI:1790741437
Name:RUIZ, HENDRYCK (MD)
Entity Type:Individual
Prefix:
First Name:HENDRYCK
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
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:JOSE DE DIEGO STREET
Mailing Address - Street 2:P.O. BOX 832
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0832
Mailing Address - Country:US
Mailing Address - Phone:787-851-6335
Mailing Address - Fax:
Practice Address - Street 1:BALDORIOTY ST. NO.18-2
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-594-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13681207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-01928Medicare UPIN
PR002-2288Medicare ID - Type UnspecifiedMEDICARE