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General NPI Number Information
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NPI Number | 1992955637
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Entity Type | Organization
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Legal Business Name | CORAL REEF GASTROENTEROLGY LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 7765 144TH STREET SUITE 6
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City | SEBASTIAN
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State | FL
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Zip | 32958
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Country | US
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Telephone | 772-589-0580
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Fax | 772-589-0760
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Provider Business Mailing Address
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Address Line | 7765 144TH STREET SUITE 6
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City | SEBASTIAN
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State | FL
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Zip | 32958
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Country | US
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Telephone | 772-589-0580
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Fax | 772-589-0760
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Authorized Official
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Title or Position | OWNER
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Name | MARGI RUIZ
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Credential |
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Telephone | 772-589-0580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME95828
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License Number State | FL
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