Healthcare Provider Details

I. General information

NPI: 1861797722
Provider Name (Legal Business Name): MARITZA J RUANO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 SW 8TH ST SUITE 204
WEST MIAMI FL
33144-5060
US

IV. Provider business mailing address

5757 SW 8TH ST SUITE 204
WEST MIAMI FL
33144-5060
US

V. Phone/Fax

Practice location:
  • Phone: 305-269-4600
  • Fax: 305-269-4800
Mailing address:
  • Phone: 305-269-4600
  • Fax: 305-269-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA42602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: