Basic Information
| Provider Information | |||||||||
| NPI: | 1881186856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | RIBEIRO FREITAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 ROOSEVELT BLVD STE 307 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191523039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677311333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8001 ROOSEVELT BLVD STE 307 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191523039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677311333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LP04297 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | MD476670 | PA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.