Provider Demographics
NPI:1851051387
Name:RUIZ, OSCAR DAMIAN (246ZC0007X)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:DAMIAN
Last Name:RUIZ
Suffix:
Gender:M
Credentials:246ZC0007X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 1ST AVE # 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6708 NW 190TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2460
Practice Address - Country:US
Practice Address - Phone:305-492-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-655246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21-655Other21-655