Provider Demographics
NPI:1427702497
Name:RUIZ MENDEZ, GRISELLE MARIE (CSW)
Entity type:Individual
Prefix:PROF
First Name:GRISELLE
Middle Name:MARIE
Last Name:RUIZ MENDEZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMUNIDAD LAS FLORES
Mailing Address - Street 2:11 CALLE MARGARITA
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-669-2770
Mailing Address - Fax:
Practice Address - Street 1:AGUADILLA MEDICAL SERVICE
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-669-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR233851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1234567890OtherNUMBER