Healthcare Provider Details

I. General information

NPI: 1891513032
Provider Name (Legal Business Name): SEBASTIAN ANDRES CANDELARIA RUIZ MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 KM 173.4 HOSPITAL LA CONCEPCION
SAN GERMAN PR
00683
US

IV. Provider business mailing address

73 CALLE PH HERNANDEZ
HATILLO PR
00659-2025
US

V. Phone/Fax

Practice location:
  • Phone: 787-659-5959
  • Fax:
Mailing address:
  • Phone: 787-397-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: