MEDICARE: ISIS MARY RUIZ URRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-73825	FL

General Provider Information

NPI Number	:	1215772322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIS MARY RUIZ URRA

Provider Business Mailing Address
First Line	:	11015 SW 156TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-1258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11015 SW 156TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-1258
Country	:	US
Telephone Number	:	305-399-9589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	06/28/2024

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