Provider Demographics
NPI:1205699436
Name:RUIZ MATOS, SEBASTIAN J
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:J
Last Name:RUIZ MATOS
Suffix:
Gender:M
Credentials:
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 1795
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-1795
Mailing Address - Country:US
Mailing Address - Phone:787-202-9009
Mailing Address - Fax:
Practice Address - Street 1:CALLE CUPEY, URB. LOS ARBOLES, #108
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-1795
Practice Address - Country:US
Practice Address - Phone:787-202-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program