Healthcare Provider Details

I. General information

NPI: 1144893447
Provider Name (Legal Business Name): CARMEN J RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 497 KM 2 BO POZAS
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 5 BOX 54488
SAN SEBASTIAN PR
00685-5806
US

V. Phone/Fax

Practice location:
  • Phone: 787-649-4251
  • Fax:
Mailing address:
  • Phone: 787-649-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14732
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier14732
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerASSMCA
# 2
IdentifierMEDICAID
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: