Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 12825 | PR |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 12825 | PR |
NPI | 1447249768 |
---|---|
Provider Name | Dr. Hiram Antonio Ruiz Santiago II |
First Address | Bayamon, PR 00959-7206 |
Second Address | Bayamon, PR 00959-7206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 29/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26193 | MEDICARE NUMBER-RCM (01) | PR |
G84826 | (02) | PR |