Healthcare Provider Details

I. General information

NPI: 1144602517
Provider Name (Legal Business Name): BEATRIZ FABIOLA MARIN RUIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2201
  • Fax: 813-974-4325
Mailing address:
  • Phone: 813-974-2201
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME151368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: