Provider Demographics
NPI:1912130527
Name:RUIZ-DE LA ROSA, ISMAEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:RUIZ-DE LA ROSA
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD
Mailing Address - Street 2:STE 475
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:181 WEBB DR STE 475
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3964
Practice Address - Country:US
Practice Address - Phone:863-419-1235
Practice Address - Fax:863-419-9525
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN922208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice