MEDICARE: DR. GUSTAVO V. RUIZ-SANTIAGO M.D.

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	174400000X	Specialist
2	2084P0800X	Psychiatry Physician	ME136835	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598755761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUSTAVO V. RUIZ-SANTIAGO M.D.

Provider Business Mailing Address
First Line	:	7726 WINEGARD RD, 2ND FLOOR STE 9
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7147
Country	:	US
Telephone Number	:	407-930-0050
Fax Number	:	407-751-4804

Provider Business Practice Location Address
First Line	:	7726 WINEGARD RD, 2ND FLOOR STE 9
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7147
Country	:	US
Telephone Number	:	407-930-0050
Fax Number	:	407-751-4804

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	02/17/2022

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