Provider Demographics
NPI:1720724354
Name:RUIZ RODRIGUEZ, MARIANA SOFIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:SOFIA
Last Name:RUIZ RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1075 CARR 2 APT 408
Mailing Address - Street 2:COND PLAZA SUCHVILLE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7341
Mailing Address - Country:US
Mailing Address - Phone:787-292-9764
Mailing Address - Fax:
Practice Address - Street 1:1075 CARR 2 APT 408
Practice Address - Street 2:COND PLAZA SUCHVILLE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7341
Practice Address - Country:US
Practice Address - Phone:787-292-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist