Healthcare Provider Details

I. General information

NPI: 1629651591
Provider Name (Legal Business Name): MICHAEL C RUIZ-THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 S ATLANTIC AVE PMB 1052
DAYTONA BEACH SHORES FL
32118
US

IV. Provider business mailing address

7903 ROXBURY CT
LANDOVER MD
20785-4205
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-3752
  • Fax:
Mailing address:
  • Phone: 262-490-0786
  • Fax: 775-392-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: