Healthcare Provider Details

I. General information

NPI: 1962971937
Provider Name (Legal Business Name): JORGE G RUIZ COIMBRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2335
US

IV. Provider business mailing address

PO BOX 7251
PONCE PR
00732-7251
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-1096
  • Fax:
Mailing address:
  • Phone: 787-362-7444
  • Fax: 787-829-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21163
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21163
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: