Provider Demographics
NPI:1578591061
Name:RUIZ ROBLES, IVELISSE C (MD)
Entity type:Individual
Prefix:DR
First Name:IVELISSE
Middle Name:C
Last Name:RUIZ ROBLES
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 1:11031 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:727-809-0093
Mailing Address - Fax:833-322-1172
Practice Address - Street 1:11031 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:727-809-0093
Practice Address - Fax:833-322-1172
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
23311ZMedicare ID - Type Unspecified
F66176Medicare UPIN