Healthcare Provider Details

I. General information

NPI: 1386848331
Provider Name (Legal Business Name): NYDIA RUIZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIDEL CASTILLO #55 EL SECO
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

FIDEL CASTILLO #55 EL SECO
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-5994
  • Fax: 787-834-1919
Mailing address:
  • Phone: 787-831-5994
  • Fax: 787-834-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number513
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: