1518117209 NPI number — DR. LUIS R RUIZ-CRUZ O.D.

Table of content: DR. LUIS R RUIZ-CRUZ O.D. (NPI 1518117209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518117209 NPI number — DR. LUIS R RUIZ-CRUZ O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ-CRUZ
Provider First Name:
LUIS
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518117209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SANTA JUANA II
Provider Second Line Business Mailing Address:
C/3 A-27
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-6885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 JOHN WILL HARRIS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-765-1915
Provider Business Practice Location Address Fax Number:
787-279-1997
Provider Enumeration Date:
09/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  048 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 661 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518117209 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "HUMANA MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "TRIPLE S MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1518117209 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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