=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689862039
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUEENLAND MORALES-RUZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 CALLE MARLIN AZUL
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-3561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-448-7328
-----------------------------------------------------
Fax | 787-858-3303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1485
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00694-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-448-7328
-----------------------------------------------------
Fax | 787-858-3303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4214
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------