Provider Demographics
NPI:1205155538
Name:CAMILO RUIZ DO PA
Entity type:Organization
Organization Name:CAMILO RUIZ DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-839-6987
Mailing Address - Street 1:1319 SE 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1809
Mailing Address - Country:US
Mailing Address - Phone:954-839-6987
Mailing Address - Fax:954-839-6923
Practice Address - Street 1:1319 SE 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1809
Practice Address - Country:US
Practice Address - Phone:954-839-6987
Practice Address - Fax:954-839-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115525000Medicaid
FLDQ885BOtherMEDICARE PTAN