Provider Demographics
NPI:1922109909
Name:RUIZ, CARLOS O (PA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:O
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:SUITE 729
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3582
Mailing Address - Country:US
Mailing Address - Phone:305-559-2779
Mailing Address - Fax:305-559-6119
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:SUITE 729
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-559-2779
Practice Address - Fax:305-559-6119
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100846363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP52223Medicare UPIN