Provider Demographics
NPI:1154192649
Name:RUIZ, MARIELYS LISET
Entity type:Individual
Prefix:
First Name:MARIELYS
Middle Name:LISET
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 SW 104TH CT APT 203
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1047
Mailing Address - Country:US
Mailing Address - Phone:786-731-7189
Mailing Address - Fax:
Practice Address - Street 1:21600 SW 104TH CT APT 203
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1047
Practice Address - Country:US
Practice Address - Phone:786-731-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-290558106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician