Provider Demographics
NPI:1316827553
Name:RUIZ, SANDRA LEONOR
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEONOR
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 1:7100 NW 177TH ST APT 209
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6244
Mailing Address - Country:US
Mailing Address - Phone:786-712-8763
Mailing Address - Fax:
Practice Address - Street 1:7100 NW 177TH ST APT 209
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6244
Practice Address - Country:US
Practice Address - Phone:786-712-8763
Practice Address - Fax:786-712-8763
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-362064106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician