Healthcare Provider Details

I. General information

NPI: 1700647427
Provider Name (Legal Business Name): NELISLEIDYS RUIZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 W 4TH AVE APT 303
HIALEAH FL
33014-5194
US

IV. Provider business mailing address

7222 W 4TH AVE APT 303 7222 W 4TH AVE APT 303
HIALEAH FL
33014-5194
US

V. Phone/Fax

Practice location:
  • Phone: 786-255-4516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB958021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: