Provider Demographics
NPI:1295812410
Name:RUIZ RIVERA, CARLA (MD)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:RUIZ RIVERA
Suffix:
Gender:F
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:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7625
Mailing Address - Country:US
Mailing Address - Phone:787-841-2928
Mailing Address - Fax:787-841-2928
Practice Address - Street 1:503 CALLE RAMON ANTONINI APTO #3
Practice Address - Street 2:NUA VIDA EL TUGUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-841-2928
Practice Address - Fax:787-841-2928
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82592Medicaid
PR82592Medicare ID - Type Unspecified
PR82592Medicaid