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General NPI Number Information
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NPI Number | 1598755761
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Entity Type | Individual
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Provider Name | GUSTAVO V. RUIZ-SANTIAGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 7726 WINEGARD RD, 2ND FLOOR STE 9
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City | ORLANDO
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State | FL
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Zip | 32809-7147
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Country | US
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Telephone | 407-930-0050
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Fax | 407-751-4804
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Provider Business Mailing Address
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Address Line | 7726 WINEGARD RD, 2ND FLOOR STE 9
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City | ORLANDO
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State | FL
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Zip | 32809-7147
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Country | US
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Telephone | 407-930-0050
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Fax | 407-751-4804
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME136835
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License Number State | FL
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