Provider Demographics
NPI:1891960803
Name:MARIN RUIZ, ALEJANDRA V (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:V
Last Name:MARIN RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 VIRGINIA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6612
Mailing Address - Country:US
Mailing Address - Phone:727-736-3212
Mailing Address - Fax:813-635-2635
Practice Address - Street 1:646 VIRGINIA ST STE 601
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-736-3212
Practice Address - Fax:813-635-2635
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128541207R00000X, 208M00000X, 207R00000X
MA247449208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022826700Medicaid
FLMD0L8OtherBLUE CROSS BLUE SHIELD