Healthcare Provider Details

I. General information

NPI: 1376723981
Provider Name (Legal Business Name): JUAN MANUEL RUIZ HURTARTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

100 PERKINS FARM DR STE 303
MYSTIC CT
06355-4041
US

V. Phone/Fax

Practice location:
  • Phone: 267-251-3588
  • Fax:
Mailing address:
  • Phone: 267-251-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT195756
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number66872
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD60272371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: