Provider Demographics
NPI:1508864356
Name:RUIZ, KARELIA
Entity Type:Individual
Prefix:
First Name:KARELIA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 W 20TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1821
Mailing Address - Country:US
Mailing Address - Phone:305-828-9100
Mailing Address - Fax:305-828-5553
Practice Address - Street 1:7600 W 20TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:305-828-9100
Practice Address - Fax:305-828-5553
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272898200Medicaid
FLI01929Medicare UPIN
FL16398ZMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER