Healthcare Provider Details

I. General information

NPI: 1033728993
Provider Name (Legal Business Name): RACHEL RUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26790 SW 142ND AVE APT 101
NARANJA FL
33032-5425
US

IV. Provider business mailing address

26790 SW 142ND AVE APT 101
NARANJA FL
33032-5425
US

V. Phone/Fax

Practice location:
  • Phone: 786-342-9700
  • Fax:
Mailing address:
  • Phone: 786-342-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-125731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: