Provider Demographics
NPI:1972903367
Name:RUIZ DE JESUS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RUIZ DE JESUS
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:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00617
Mailing Address - Country:UM
Mailing Address - Phone:787-407-6019
Mailing Address - Fax:
Practice Address - Street 1:BO. IMBERY INTERSECCION LOS ROSALES
Practice Address - Street 2:CALLE 2
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-407-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program