Provider Demographics
NPI:1356380455
Name:RUIZ MUNIZ, LYDIA I (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:I
Last Name:RUIZ MUNIZ
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:URB. VILLA ANTILLANA
Mailing Address - Street 2:AN-32 PLAZA SAN VICENTE
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-646-1394
Mailing Address - Fax:787-768-0120
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:PRIMER NIVEL SUITE 7
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-768-0120
Practice Address - Fax:787-768-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9612208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF94450Medicare UPIN
PR0083344Medicare ID - Type Unspecified