=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619113263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DORADO OB-GYN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2009
-----------------------------------------------------
Last Update Date | 01/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 CALLE MENDEZ VIGO
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-4917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-278-2393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 362 CALLE SABALO
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-278-2393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. WILLIAM RUIZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-278-2393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------