Healthcare Provider Details

I. General information

NPI: 1881679298
Provider Name (Legal Business Name): IGNACIO CORADIN RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAGUABO MEDICAL MALL CARR 31 KM 4.0
NAGUABO PR
00718-0001
US

IV. Provider business mailing address

2048 FERNANDO DE ROJAS URB EL SENORIAL
SAN JUAN PR
00926-6929
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-3152
  • Fax: 787-874-3125
Mailing address:
  • Phone: 939-456-4787
  • Fax: 787-874-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11535
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: