Healthcare Provider Details

I. General information

NPI: 1902630213
Provider Name (Legal Business Name): KEYLA ALVAREZ RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LAKELAND HIGHLANDS RD
LAKELAND FL
33812-4507
US

IV. Provider business mailing address

4489 YAUPON HOLLY WAY
LAKELAND FL
33811-2773
US

V. Phone/Fax

Practice location:
  • Phone: 813-716-9242
  • Fax:
Mailing address:
  • Phone: 813-716-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: