Healthcare Provider Details

I. General information

NPI: 1093934259
Provider Name (Legal Business Name): SHEILA RUIZ SANTA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. SANTA JUANITA WP 3
BAYAMON PR
00956
US

IV. Provider business mailing address

STREET 32 MM 25 SANTA JUANITA
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-2608
  • Fax: 787-740-2612
Mailing address:
  • Phone: 787-402-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number906
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: