Healthcare Provider Details

I. General information

NPI: 1760459937
Provider Name (Legal Business Name): ROSIBEL RUIZ DM.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAMARYS SALVA SECRETARY

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27A CALLE BETANCES
UTUADO PR
00641-2862
US

IV. Provider business mailing address

PO BOX 425
UTUADO PR
00641-0425
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-1460
  • Fax: 787-814-0546
Mailing address:
  • Phone: 787-894-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1270
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: