Healthcare Provider Details

I. General information

NPI: 1801834742
Provider Name (Legal Business Name): EMILIO I RUIZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 119 KM 26.6
SAN SEBASTIAN PR
00685-9745
US

IV. Provider business mailing address

HC 1 BOX 10918
SAN SEBASTIAN PR
00685-9745
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-0045
  • Fax: 787-818-0429
Mailing address:
  • Phone: 787-896-0045
  • Fax: 787-818-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberTCAMB 213
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: