Healthcare Provider Details

I. General information

NPI: 1073637310
Provider Name (Legal Business Name): VERA RUIZ FAMILY MEDICINE, CSP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AVE LA MOCA # KM3.0
MOCA PR
00676-4001
US

IV. Provider business mailing address

PO BOX 6
MOCA PR
00676-0006
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-1266
  • Fax: 787-877-3813
Mailing address:
  • Phone: 787-818-1266
  • Fax: 787-877-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE VERA QUINONES
Title or Position: SECRETARIO
Credential: MD
Phone: 787-818-1266