Healthcare Provider Details

I. General information

NPI: 1235112368
Provider Name (Legal Business Name): ANA T QULIES RUIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF MULTIFABRIL OFIC 201
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

823 CAMINO EL GUAYO
MAYAGUEZ PR
00680-8117
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-2691
  • Fax:
Mailing address:
  • Phone: 787-834-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9948
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: