Healthcare Provider Details

I. General information

NPI: 1023029626
Provider Name (Legal Business Name): ANTONIA E RUAIX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27 AVE #604
MIAMI FL
33135
US

IV. Provider business mailing address

330 SW 27 AVE #604
MIAMI FL
33135
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-0332
  • Fax:
Mailing address:
  • Phone: 305-642-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0049854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: