Healthcare Provider Details

I. General information

NPI: 1184065104
Provider Name (Legal Business Name): MARINELIS RUIZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. EL RETIRO 1 EXOTICA BUILDING
HUMACAO PR
00791
US

IV. Provider business mailing address

HC 61 BOX 5354
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-215-3823
  • Fax:
Mailing address:
  • Phone: 787-215-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3274
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1027
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1071
License Number StatePR

VIII. Authorized Official

Name: MS. MARINELIS RUIZ
Title or Position: CEO
Credential: MS-SLP
Phone: 787-215-3823