Provider Demographics
NPI:1902569171
Name:RUIZ, ANDY RAFAEL (DC)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:RAFAEL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10015
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9015
Mailing Address - Country:US
Mailing Address - Phone:787-310-8748
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PLAZA MILIANGIE BO. MONTELLANO CARR 14
Practice Address - Street 2:LOCAL 5
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-310-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR805111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation