MEDICARE: DR. JOSE L RUIZ M.D.

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	207Q00000X	Family Medicine Physician	11354	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87996RU	OTHER	PR	TRIPLE-S

General Provider Information

NPI Number	:	1457329484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE L RUIZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 142378
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-2378
Country	:	US
Telephone Number	:	787-317-2305
Fax Number	:	787-817-7181

Provider Business Practice Location Address
First Line	:	860 AVE MIRAMAR
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-2724
Country	:	US
Telephone Number	:	787-317-2305
Fax Number	:	787-881-7181

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	10/20/2011

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