Healthcare Provider Details

I. General information

NPI: 1447783246
Provider Name (Legal Business Name): MAYTE SOLANGE RUIZ SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW 57TH AVE STE 106
MIAMI FL
33155-2164
US

IV. Provider business mailing address

52 S ROYAL POINCIANA BLVD
MIAMI SPRINGS FL
33166-6059
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-1701
  • Fax: 305-847-2447
Mailing address:
  • Phone: 786-536-1701
  • Fax: 305-847-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number144232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: