Healthcare Provider Details

I. General information

NPI: 1992967384
Provider Name (Legal Business Name): MARINA C. RUIZ-MONTILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND SAN JORGE 258
SANTURCE PR
00912-3302
US

IV. Provider business mailing address

258 CALLE SAN JORGE
SANTURCE PR
00912
US

V. Phone/Fax

Practice location:
  • Phone: 787-349-9179
  • Fax:
Mailing address:
  • Phone: 787-349-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18387
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number18387
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: