Provider Demographics
NPI:1992967384
Name:RUIZ-MONTILLA, MARINA C (MD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:C
Last Name:RUIZ-MONTILLA
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 1:258 CALLE SAN JORGE
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-349-9179
Mailing Address - Fax:
Practice Address - Street 1:COND SAN JORGE
Practice Address - Street 2:258
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3302
Practice Address - Country:US
Practice Address - Phone:787-349-9179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18387208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics