Healthcare Provider Details

I. General information

NPI: 1861610669
Provider Name (Legal Business Name): MARTA M. RUIZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS DEPARTMENT OF PSYCHIATRY 9TH FLOOR
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

COND. MIRAMAR TOWERS CALLE HERNANDEZ 721 APT. 14 G
SAN JUAN PR
00907-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-764-7004
Mailing address:
  • Phone: 787-723-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2443
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: