Healthcare Provider Details

I. General information

NPI: 1003915653
Provider Name (Legal Business Name): NYDIA RUIZ JUSINO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION SANTA MARIA SHOPPING CENTER OFICINA #234 COMMUNITY CORNERSTONE OF PUERTO RICO
PONCE PR
00737
US

IV. Provider business mailing address

CALLE ALDA # 1549 URB ARIZACOON CARIBE
RIO PIEDRAS PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-0030
  • Fax: 787-651-0033
Mailing address:
  • Phone: 787-622-9797
  • Fax: 787-622-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7618
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: