Provider Demographics
NPI:1528146974
Name:ROMERO RUIZ, BELKYS ALTAGRACIA (MD)
Entity type:Individual
Prefix:MRS
First Name:BELKYS
Middle Name:ALTAGRACIA
Last Name:ROMERO RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELKYS
Other - Middle Name:A
Other - Last Name:BONNELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:315 WEST 49 STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-828-7374
Mailing Address - Fax:305-828-7744
Practice Address - Street 1:315 WEST 49 STREET
Practice Address - Street 2:SUITE B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-828-7374
Practice Address - Fax:305-828-7744
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255338401Medicaid