Provider Demographics
NPI:1801929518
Name:MORA-RUIZ, EDWIN A (MD)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:A
Last Name:MORA-RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9220
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9220
Mailing Address - Country:US
Mailing Address - Phone:787-740-1011
Mailing Address - Fax:787-740-1008
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 503
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-740-1011
Practice Address - Fax:787-740-1008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8838207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080001OtherMEDICARE PROVIDER
PR0080001OtherMEDICARE PROVIDER