Provider Demographics
NPI:1538455225
Name:CORONA RUIZ, JUAN MARIO (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MARIO
Last Name:CORONA RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:MARIO
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2120 E JOHNSON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6091
Mailing Address - Country:US
Mailing Address - Phone:850-494-6003
Mailing Address - Fax:850-494-6936
Practice Address - Street 1:2120 E JOHNSON AVE STE 106
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6091
Practice Address - Country:US
Practice Address - Phone:850-494-6003
Practice Address - Fax:850-494-6936
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME152543207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program