Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6138 | PR |
NPI | 1003465089 |
---|---|
Provider Name | Maria M Ruiz |
First Address | Isabela, PR 00662-3903 |
Second Address | Toa Baja, PR 00949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |