Healthcare Provider Details

I. General information

NPI: 1265172977
Provider Name (Legal Business Name): JAVIER ANTONIO RUIZ ADAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT STE 410
SAN JUAN PR
00918-2163
US

IV. Provider business mailing address

400 AVE FD ROOSEVELT STE 410
SAN JUAN PR
00918-2163
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6414
  • Fax:
Mailing address:
  • Phone: 787-753-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23819
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: