Healthcare Provider Details

I. General information

NPI: 1417877887
Provider Name (Legal Business Name): JOSE LUIZ RUIZ ALVARADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PR-696
DORADO PR
00646
US

IV. Provider business mailing address

1 RES PLAZUELA # 257
BARCELONETA PR
00617-2600
US

V. Phone/Fax

Practice location:
  • Phone: 787-433-1294
  • Fax:
Mailing address:
  • Phone: 787-433-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17777-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: