Healthcare Provider Details

I. General information

NPI: 1255010260
Provider Name (Legal Business Name): YANSMARIE RUIZ ADS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 R 455 K1 H7 BO QUEBRADA
CAMUY PR
00669-9125
US

IV. Provider business mailing address

CARR 129 R 455 K1 H7 BO QUEBRADA HC 2 BUZON 7846
CAMUY PR
00627-9125
US

V. Phone/Fax

Practice location:
  • Phone: 787-639-0639
  • Fax:
Mailing address:
  • Phone: 787-639-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number39265
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: