Provider Demographics
NPI:1649967290
Name:RUIZ, ANGEL DANIEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:DANIEL
Last Name:RUIZ
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 1:2011 S SEMORAN BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2897
Mailing Address - Country:US
Mailing Address - Phone:786-873-6609
Mailing Address - Fax:
Practice Address - Street 1:2011 S SEMORAN BLVD APT C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2897
Practice Address - Country:US
Practice Address - Phone:786-873-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-268011106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician