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General NPI Number Information
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NPI Number | 1386460129
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Entity Type | Individual
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Provider Name | LISSETTE PABON RUIZ I MSW
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 230 AV. JOSE GAUTIER BENITEZ,
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-296-9776
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370466
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City | CAYEY
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State | PR
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Zip | 00737-0466
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Country | US
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Telephone | 939-247-0700
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16923
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License Number State | PR
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