Provider Demographics
NPI:1982635694
Name:RUIZ-BERMUDEZ, OSCAR L (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:L
Last Name:RUIZ-BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AVE CARLOS CHARDON APT 137
Mailing Address - Street 2:QUANTUM METROCENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-263-0702
Mailing Address - Fax:787-263-0702
Practice Address - Street 1:120 AVE CARLOS CHARDON APT 137
Practice Address - Street 2:QUANTUM METROCENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-901-6198
Practice Address - Fax:787-263-0702
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16061207RE0101X
PR16,061208D00000X
LAMD.205086208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06205895Medicaid
LA4Q7567061Medicare PIN
LA2181742Medicaid