Provider Demographics
NPI:1982632485
Name:RUIZ, LESBIA I (MD)
Entity Type:Individual
Prefix:
First Name:LESBIA
Middle Name:I
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESBIA
Other - Middle Name:
Other - Last Name:RUIZ SANTIAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:787-854-1040
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:829 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2084
Practice Address - Country:US
Practice Address - Phone:407-332-0003
Practice Address - Fax:321-295-7928
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133957207Q00000X
PR11980208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11980OtherMEDICAL LICENSE
FLME133957OtherFLORIDA MEDICAL LICENSE