Provider Demographics
NPI:1144057308
Name:RUIZ NIZARANE, YISEL
Entity type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:RUIZ NIZARANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NW 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6815
Mailing Address - Country:US
Mailing Address - Phone:786-294-4833
Mailing Address - Fax:
Practice Address - Street 1:150 NW 86TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-6815
Practice Address - Country:US
Practice Address - Phone:786-294-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-378353106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician