Provider Demographics
NPI:1487100905
Name:LUIS RUIZ, SUKNAY
Entity type:Individual
Prefix:
First Name:SUKNAY
Middle Name:
Last Name:LUIS 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 1:17511 NW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3619
Mailing Address - Country:US
Mailing Address - Phone:786-484-4580
Mailing Address - Fax:
Practice Address - Street 1:17511 NW 49TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3619
Practice Address - Country:US
Practice Address - Phone:786-484-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-1613417106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician