MEDICARE: ILIANA 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1275762361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILIANA RUIZ

Provider Business Mailing Address
First Line	:	860 AVE MIRAMAR
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-2724
Country	:	US
Telephone Number	:	787-878-9833
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 AVE MIRAMAR
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-2724
Country	:	US
Telephone Number	:	787-878-9833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ILIANA A. RUIZ
Credential	:	M.T.
Telephone Number	:	787-878-9833

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	09/09/2009

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Directions to “ILIANA RUIZ ” Practice Location

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