Healthcare Provider Details

I. General information

NPI: 1952775199
Provider Name (Legal Business Name): SERGE RONALD RUIZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 W 20TH AVE
HIALEAH FL
33012-2101
US

IV. Provider business mailing address

860 NW 42ND AVE FL 5
MIAMI FL
33126-4172
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0333
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-204-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9311770
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9311770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: