Provider Demographics
NPI:1174762306
Name:RUIZ ALTIERI, WILSON J
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:J
Last Name:RUIZ ALTIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE AGUAS BUENAS 16-29
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6661
Mailing Address - Country:US
Mailing Address - Phone:787-395-7410
Mailing Address - Fax:
Practice Address - Street 1:AVE AGUAS BUENAS 16-29
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:PR
Practice Address - Zip Code:00959-6661
Practice Address - Country:US
Practice Address - Phone:787-395-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6410510001Medicare NSC