Healthcare Provider Details

I. General information

NPI: 1477110336
Provider Name (Legal Business Name): RICARDO RUIZ JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

IV. Provider business mailing address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8644
  • Fax: 305-689-1820
Mailing address:
  • Phone: 305-243-8644
  • Fax: 305-689-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: