Provider Demographics
NPI:1942411905
Name:RUIZ, TANIA A (BAPH)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:BAPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 47171
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9702
Mailing Address - Country:US
Mailing Address - Phone:787-882-3354
Mailing Address - Fax:
Practice Address - Street 1:AVE.GENERAL RAMEY #1052
Practice Address - Street 2:POBLADO SAN ANTONIO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00690
Practice Address - Country:US
Practice Address - Phone:787-890-3340
Practice Address - Fax:787-890-1233
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist