Provider Demographics
NPI:1215467519
Name:CLASE, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CLASE
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 1:5505 ANDORA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1643
Mailing Address - Country:US
Mailing Address - Phone:407-218-0225
Mailing Address - Fax:
Practice Address - Street 1:5505 ANDORA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1643
Practice Address - Country:US
Practice Address - Phone:407-218-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician