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General NPI Number Information
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NPI Number | 1144771049
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Entity Type | Individual
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Provider Name | FREDY RUIZ P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 3211 PONCE DE LEON BLVD SUITE 102
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City | CORAL GABLES
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State | FL
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Zip | 33134-7274
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Country | US
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Telephone | 305-443-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 NW 99TH PL
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City | DORAL
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State | FL
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Zip | 33172-1046
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Country | US
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Telephone | 786-261-8763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9109956
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9109956
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License Number State | FL
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