Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 12684 | PR |
NPI | 1245219864 |
---|---|
Provider Name | Maria De Los Angeles Ruiz |
First Address | Mayaguez, PR 00680 |
Second Address | Mayaguez, PR 00680 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 16/02/2011 |