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General NPI Number Information
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NPI Number | 1780864991
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Entity Type | Organization
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Legal Business Name | JOSE LUIS RUIZ MD PA
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST STE 304
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City | CUTLER BAY
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 305-971-6883
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Fax | 305-971-6836
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Provider Business Mailing Address
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Address Line | 11285 SW 211TH ST STE 304
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City | CUTLER BAY
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 305-971-6883
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Fax | 305-971-6836
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSE L RUIZ
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Credential | MD
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Telephone | 305-971-6883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME066055
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License Number State | FL
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