Provider Demographics
NPI:1902958499
Name:RUIZ SIERRA, LUIS H (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:H
Last Name:RUIZ SIERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 ADUANA STREET
Mailing Address - Street 2:SUITE 364
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-833-5898
Mailing Address - Fax:
Practice Address - Street 1:4040 CALLE B STE 4
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1378
Practice Address - Country:US
Practice Address - Phone:787-833-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11197208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG04576Medicare UPIN