Provider Demographics
NPI:1194614685
Name:RUIZ CORDERO, PATRICA
Entity type:Individual
Prefix:
First Name:PATRICA
Middle Name:
Last Name:RUIZ CORDERO
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 1:25821 S DIXIE HWY APT 915
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5540
Mailing Address - Country:US
Mailing Address - Phone:786-203-7594
Mailing Address - Fax:
Practice Address - Street 1:25821 S DIXIE HWY APT 915
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5540
Practice Address - Country:US
Practice Address - Phone:786-203-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1321915106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician