Provider Demographics
NPI:1801887518
Name:RUIZ, LYNNETTE (MD)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 TANDORI CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7521
Mailing Address - Country:US
Mailing Address - Phone:939-644-3118
Mailing Address - Fax:
Practice Address - Street 1:1962 N JOHN YOUNG PKWY
Practice Address - Street 2:USA MED CARE
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-935-0623
Practice Address - Fax:407-809-5245
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14989208D00000X
FLACN522208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98376Medicare ID - Type Unspecified