Healthcare Provider Details

I. General information

NPI: 1679647903
Provider Name (Legal Business Name): LUZ TARINA RUIZ VELEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUZ TARINA RUIZ VELEZ M.D.

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CALLE MUNOZ RIVERA
PENUELAS PR
00624-1402
US

IV. Provider business mailing address

PO BOX 561
YAUCO PR
00698-0561
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-1127
  • Fax:
Mailing address:
  • Phone: 787-836-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13935
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: