Provider Demographics
NPI:1821767237
Name:RUIZ PEREZ, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:RUIZ PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 CULTURAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1213
Mailing Address - Country:US
Mailing Address - Phone:786-458-6629
Mailing Address - Fax:
Practice Address - Street 1:531 CULTURAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1213
Practice Address - Country:US
Practice Address - Phone:786-458-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician