Provider Demographics
NPI:1487082947
Name:RUIZ-TUDO, GABRIELLE A (MA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:A
Last Name:RUIZ-TUDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CALLE COSTA RICA
Mailing Address - Street 2:APT. 12-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2417
Mailing Address - Country:US
Mailing Address - Phone:832-775-5444
Mailing Address - Fax:
Practice Address - Street 1:1666 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3145
Practice Address - Country:US
Practice Address - Phone:787-941-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3814103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool