Provider Demographics
NPI:1861844524
Name:RUIZ, CELINA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CELINA
Middle Name:ANN
Last Name:RUIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CELINA
Other - Middle Name:ANN
Other - Last Name:DIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:355 NE 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2854
Mailing Address - Country:US
Mailing Address - Phone:786-514-5495
Mailing Address - Fax:
Practice Address - Street 1:370 SAN LORENZO AVE STE 2415
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1869
Practice Address - Country:US
Practice Address - Phone:305-461-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOPC 5311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC5311OtherOPTOMETRY LICENSE