Healthcare Provider Details

I. General information

NPI: 1811815988
Provider Name (Legal Business Name): IMABET SANTIAGO RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA INTERAMERICANA SUITE # 217 (PLAZA VALLE VERDE)
SAN GERMAN PR
00683
US

IV. Provider business mailing address

235 CALLE VISTA LINDA
SABANA GRANDE PR
00637-1616
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1196
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: