Provider Demographics
NPI:1598516148
Name:ANDUJAR RUIZ, MARCOS GABRIEL (RN, BSN)
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:GABRIEL
Last Name:ANDUJAR RUIZ
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CALLE AMERICO SALAS APT 802
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2129
Mailing Address - Country:US
Mailing Address - Phone:939-318-6465
Mailing Address - Fax:
Practice Address - Street 1:1414 CALLE AMERICO SALAS APT 802
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2129
Practice Address - Country:US
Practice Address - Phone:939-318-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97757163WA0400X, 163WC0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine