Individual
LOURDES CARRERO-RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3487 BROADWAY AVENUE, FORT MYERS, FL 33901-7213
(239) 334-9555
(239) 334-2832
Mailing address
3487 BROADWAY AVENUE, FORT MYERS, FL 33901-7213
(239) 334-9555
(239) 334-2832
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
10482
PR
208D00000X
General Practice Physician
Primary
ACN117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003953400
—
FL
01
—
IZ052X
MEDICARE
FL
Enumeration date
04/17/2006
Last updated
12/02/2020
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