Provider Demographics
NPI:1962104224
Name:RUIZ DE MERCADO, PAOLI K
Entity type:Individual
Prefix:
First Name:PAOLI
Middle Name:K
Last Name:RUIZ DE MERCADO
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 1:10770 NW 76TH LN
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2322
Mailing Address - Country:US
Mailing Address - Phone:786-637-0100
Mailing Address - Fax:
Practice Address - Street 1:10770 NW 76TH LN
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2322
Practice Address - Country:US
Practice Address - Phone:786-637-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist