Provider Demographics
NPI:1316902067
Name:RUIZ QUIJANO, EDNA M (MD)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:M
Last Name:RUIZ QUIJANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:M
Other - Last Name:RUIZ QUIJANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3RD ST C-4 ROMANY PARK
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-720-1549
Mailing Address - Fax:787-720-1858
Practice Address - Street 1:CASIA ST 10 VA MEDICAL CENTER
Practice Address - Street 2:RADIOLOGY SERVICE 114
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-758-7575
Practice Address - Fax:787-641-2965
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
81901Medicare ID - Type Unspecified