Basic Information
Provider Information
NPI: 1760673289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUIZ ZAITA
FirstName: ALAIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D,
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 551420
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333551420
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber: 8558514405
Practice Location
Address1: 3001 W DR MARTIN LUTHER KING JR BLVD
Address2:  
City: TAMPA
State: FL
PostalCode: 336076307
CountryCode: US
TelephoneNumber: 8133507244
FaxNumber: 8133507246
Other Information
ProviderEnumerationDate: 08/08/2007
LastUpdateDate: 03/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME103290FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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