Healthcare Provider Details

I. General information

NPI: 1285337899
Provider Name (Legal Business Name): LISIBET I RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E 25TH ST
HIALEAH FL
33013-3814
US

IV. Provider business mailing address

15251 NW 88TH AVE
MIAMI LAKES FL
33018-1361
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-6100
  • Fax:
Mailing address:
  • Phone: 305-799-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number145357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: