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General NPI Number Information
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NPI Number | 1649727405
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Entity Type | Individual
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Provider Name | JENNIFER RUIZ BOADA MD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | HOSPITAL PEDIATRICO UNIVERSITARIO DR ANTONIO ORTIZ CARRETERA 22 BARRIO MONACILLOS, CENTRO MEDICO
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City | RIO PIEDRAS
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State | PR
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Zip | 00935
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Country | US
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Telephone | 787-474-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 AVE ASHFORD APT 602
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City | SAN JUAN
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State | PR
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Zip | 00911-1168
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Country | US
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Telephone | 787-292-9994
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 21409
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 21409
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License Number State | PR
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