Healthcare Provider Details

I. General information

NPI: 1457061921
Provider Name (Legal Business Name): FELICITY DIANE RUIZ CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

7629 SWILCAN DR APT 3200
ORLANDO FL
32822-5052
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-6030
  • Fax:
Mailing address:
  • Phone: 813-953-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: