Provider Demographics
NPI:1447478581
Name:RUIZ, ANGEL MIGUEL (COF)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:MIGUEL
Last Name:RUIZ
Suffix:
Gender:M
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F1 CALLE CRONOS
Mailing Address - Street 2:VILLAS DE BUENA VISTA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5944
Mailing Address - Country:US
Mailing Address - Phone:787-279-9358
Mailing Address - Fax:787-279-9383
Practice Address - Street 1:CARRETERA 829 AA 4
Practice Address - Street 2:URBANIZACION VANS COY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-279-9358
Practice Address - Fax:787-279-9383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4964350001Medicare NSC