Healthcare Provider Details

I. General information

NPI: 1285739060
Provider Name (Legal Business Name): JOSE DAVID RUIZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 LAKE UNDERHILL RD STE 113
ORLANDO FL
32825-4434
US

IV. Provider business mailing address

10967 LAKE UNDERHILL RD STE 113
ORLANDO FL
32825-4434
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax:
Mailing address:
  • Phone: 833-769-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME85967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: