Provider Demographics
NPI:1881679298
Name:CORADIN RUIZ, IGNACIO (MD)
Entity type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:CORADIN RUIZ
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2048 FERNANDO DE ROJAS
Mailing Address - Street 2:URB EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6929
Mailing Address - Country:US
Mailing Address - Phone:939-456-4787
Mailing Address - Fax:787-874-3125
Practice Address - Street 1:NAGUABO MEDICAL MALL
Practice Address - Street 2:CARR 31 KM 4.0
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-0001
Practice Address - Country:US
Practice Address - Phone:787-874-3152
Practice Address - Fax:787-874-3125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2018-07-24
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Provider Licenses
StateLicense IDTaxonomies
PR11535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH83779Medicare UPIN
PR0088983Medicare ID - Type Unspecified