Healthcare Provider Details

I. General information

NPI: 1205766276
Provider Name (Legal Business Name): SERGY EMIL RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 KM 173.4
SAN GERMAN PR
00683
US

IV. Provider business mailing address

7034 CALLE CESARINA GONZE
MAYAGUEZ PR
00680-1941
US

V. Phone/Fax

Practice location:
  • Phone: 787-659-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17-776-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: