Provider Demographics
NPI:1144258245
Name:RUIZ, BRENDA M
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:RUIZ
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:BRISAS DE ANASCO CALLE 10 GG-14 ANASCO
Mailing Address - Street 2:P.O.BOX 486 ANASCO
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0486
Mailing Address - Country:US
Mailing Address - Phone:787-826-2347
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA ESQUINA SAN JUSTO
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15675208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022961Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRI27852Medicare UPIN