Provider Demographics
NPI:1740699933
Name:RUIZ VEGA, KARLA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
Last Name:RUIZ VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 AVE CONSTITUCION APT 2201
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2261
Mailing Address - Country:US
Mailing Address - Phone:787-294-1525
Mailing Address - Fax:
Practice Address - Street 1:435 AVE PONCE DE LEON HOSPITAL PAVIA HATO REY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-641-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21838208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery