MEDICARE: LUIS CABAN RUIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114808524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS CABAN RUIZ

Provider Business Mailing Address
First Line	:	468 CALLE LIRIO
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S MILLER ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4436
Country	:	US
Telephone Number	:	787-203-7313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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