Provider Demographics
NPI:1699923987
Name:RUIZ, LYZBETH (PHL)
Entity type:Individual
Prefix:
First Name:LYZBETH
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 AVE MONTE CARLO APT 286
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5715
Mailing Address - Country:US
Mailing Address - Phone:787-613-6249
Mailing Address - Fax:
Practice Address - Street 1:1306 AVE MONTE CARLO APT 286
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5715
Practice Address - Country:US
Practice Address - Phone:787-613-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist