Healthcare Provider Details

I. General information

NPI: 1508804766
Provider Name (Legal Business Name): CARLOS HERIBERTO RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-1370
  • Fax:
Mailing address:
  • Phone: 407-601-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME80316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: