Provider Demographics
NPI:1851479547
Name:RUIZ, YAISA Z (OD)
Entity Type:Individual
Prefix:
First Name:YAISA
Middle Name:Z
Last Name:RUIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0163
Mailing Address - Country:US
Mailing Address - Phone:787-898-8838
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE PH HERNANDEZ
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2007
Practice Address - Country:US
Practice Address - Phone:787-898-8838
Practice Address - Fax:787-820-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist