Provider Demographics
NPI:1720157092
Name:RUIZ, LIZZETTE (1252)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:1252
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APDO 191
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670
Mailing Address - Country:US
Mailing Address - Phone:787-986-0227
Mailing Address - Fax:787-834-9408
Practice Address - Street 1:CARR 397 KM 0.6
Practice Address - Street 2:BO FURNIAS
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670
Practice Address - Country:US
Practice Address - Phone:787-986-0227
Practice Address - Fax:787-834-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1252183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician