Healthcare Provider Details

I. General information

NPI: 1346268695
Provider Name (Legal Business Name): CESAR L RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 E VINE ST
KISSIMMEE FL
34744-3740
US

IV. Provider business mailing address

5452 NW 49TH CT
COCONUT CREEK FL
33073-3307
US

V. Phone/Fax

Practice location:
  • Phone: 407-931-3155
  • Fax: 407-931-0955
Mailing address:
  • Phone: 954-420-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME25258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: