Healthcare Provider Details

I. General information

NPI: 1790741437
Provider Name (Legal Business Name): HENDRYCK RUIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BALDORIOTY ST. NO.18-2
YAUCO PR
00698
US

IV. Provider business mailing address

JOSE DE DIEGO STREET P.O. BOX 832
BOQUERON PR
00622-0832
US

V. Phone/Fax

Practice location:
  • Phone: 787-594-4035
  • Fax:
Mailing address:
  • Phone: 787-851-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number13681
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: