Provider Demographics
NPI:1861797722
Name:RUANO, MARITZA J (MA)
Entity type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:J
Last Name:RUANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 SW 8TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5060
Mailing Address - Country:US
Mailing Address - Phone:305-269-4600
Mailing Address - Fax:305-269-4800
Practice Address - Street 1:5757 SW 8TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5060
Practice Address - Country:US
Practice Address - Phone:305-269-4600
Practice Address - Fax:305-269-4800
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist