Basic Information
| Provider Information | |||||||||
| NPI: | 1740699933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ VEGA | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 AVE CONSTITUCION APT 2201 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009012261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872941525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 431 AVE PONCE DE LEON STE 327 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009173403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876412323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 21838 | PR | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 21838 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.