Basic Information
| Provider Information | |||||||||
| NPI: | 1508536863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | LORELL | ||||||||
| MiddleName: | VERONICA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 CALLE FIGARO | ||||||||
| Address2: | |||||||||
| City: | HATILLO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006591659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872333849 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 431 AVE HOSTOS | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009183014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2021 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11847 | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.