Provider Demographics
NPI:1902630213
Name:ALVAREZ RUIZ, KEYLA
Entity type:Individual
Prefix:
First Name:KEYLA
Middle Name:
Last Name:ALVAREZ 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 1:4316 TROTTERS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-9670
Mailing Address - Country:US
Mailing Address - Phone:813-716-9242
Mailing Address - Fax:
Practice Address - Street 1:1818 HARDEN BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1824
Practice Address - Country:US
Practice Address - Phone:863-683-4726
Practice Address - Fax:863-682-1705
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25513225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics