Provider Demographics
NPI:1255010260
Name:RUIZ, YANSMARIE (ADS)
Entity type:Individual
Prefix:MISS
First Name:YANSMARIE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 129 R 455 K1 H7 BO QUEBRADA
Mailing Address - Street 2:HC 2 BUZON 7846
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9125
Mailing Address - Country:US
Mailing Address - Phone:787-639-0639
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 R 455 K1 H7 BO QUEBRADA
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00669-9125
Practice Address - Country:US
Practice Address - Phone:787-639-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR39265376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty