Healthcare Provider Details

I. General information

NPI: 1760810550
Provider Name (Legal Business Name): VIPSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 LAKE MELROSE DR
ORLANDO FL
32829-7690
US

IV. Provider business mailing address

5895 LAKE MELROSE DR
ORLANDO FL
32829-7690
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-4261
  • Fax:
Mailing address:
  • Phone: 407-932-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberME 80316
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS H RUIZ
Title or Position: M.D
Credential: M.D
Phone: 407-832-4261