Provider Demographics
NPI:1306151980
Name:RUIZ, RUBEN (MED)
Entity type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE 1
Mailing Address - Street 2:MANSIONES DE ANASCO
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2100
Mailing Address - Country:US
Mailing Address - Phone:787-826-7170
Mailing Address - Fax:787-826-7170
Practice Address - Street 1:1 CALLE 1
Practice Address - Street 2:MANSIONES DE ANASCO
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2100
Practice Address - Country:US
Practice Address - Phone:787-826-7170
Practice Address - Fax:787-826-7170
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1106101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool