MEDICARE: MRS. ANA MARIA RUIZ PSY.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	103TC0700X	Clinical Psychologist	4042	PR

General Provider Information

NPI Number	:	1639436884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA MARIA RUIZ PSY.D.

Provider Business Mailing Address
First Line	:	GIBRALTAR #2108 LA RAMBLA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-4083
Country	:	US
Telephone Number	:	787-449-7396
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 CALLE GIBRALTAR
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-4083
Country	:	US
Telephone Number	:	787-449-7396
Fax Number	:

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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