Provider Demographics
NPI:1922338300
Name:RUIZ, ANTUANET (OT)
Entity Type:Individual
Prefix:
First Name:ANTUANET
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:OT
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 160010
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-0001
Mailing Address - Country:US
Mailing Address - Phone:786-219-3145
Mailing Address - Fax:786-219-3155
Practice Address - Street 1:4601 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2111
Practice Address - Country:US
Practice Address - Phone:786-219-3145
Practice Address - Fax:786-219-3155
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCZ433ZMedicare PIN