Healthcare Provider Details

I. General information

NPI: 1609783612
Provider Name (Legal Business Name): ISAMAR ROSARIO RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 30 BOX 32558
SAN LORENZO PR
00754-9793
US

IV. Provider business mailing address

HC 30 BOX 32558
SAN LORENZO PR
00754-9793
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-6501
  • Fax:
Mailing address:
  • Phone: 787-773-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3760
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: