Provider Demographics
NPI:1720477102
Name:ADRIEN-RUIZ, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ADRIEN-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 1:580 ELLIS RD S
Mailing Address - Street 2:STE: 118
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3582
Mailing Address - Country:US
Mailing Address - Phone:904-423-0017
Mailing Address - Fax:904-836-1694
Practice Address - Street 1:435 CLARK RD STE 107
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5558
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:904-765-0664
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health