=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720183676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUTIERREZ RUIZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1949 W 68TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-828-9100
-----------------------------------------------------
Fax | 305-828-5553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1949 W 68TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-828-9100
-----------------------------------------------------
Fax | 305-828-5553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KARELIA RUIZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-828-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME92976
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME92389
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------