Healthcare Provider Details

I. General information

NPI: 1881506541
Provider Name (Legal Business Name): IVELISSE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER PLAZA, AVE HOSTO 740, OFICINA 310.
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

PO BOX 3549
AGUADILLA PR
00605-3549
US

V. Phone/Fax

Practice location:
  • Phone: 939-219-3379
  • Fax:
Mailing address:
  • Phone: 939-219-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8285
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: