| Live Oak Minds Llc | |
|
79 Bay Bridge Dr Gulf Breeze FL 32561-4468 | |
| (850) 741-5438 | |
| Not Available |
| Full Name | Live Oak Minds Llc |
|---|---|
| Speciality | Psychologist |
| Location | 79 Bay Bridge Dr, Gulf Breeze, Florida |
| Authorized Official Name and Position | Hope Ruiz (PRESIDENT) |
| Authorized Official Contact | 8507415438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Minds Llc 79 Bay Bridge Dr Gulf Breeze FL 32561-4468 Ph: (850) 741-5438 | Live Oak Minds Llc 79 Bay Bridge Dr Gulf Breeze FL 32561-4468 Ph: (850) 741-5438 |
| NPI Number | 1902467624 |
|---|---|
| Provider Enumeration Date | 06/24/2019 |
| Last Update Date | 06/08/2026 |
| Certification Date | 06/08/2026 |
| Medicare PECOS PAC ID | 8527395748 |
|---|---|
| Medicare Enrollment ID | O20190812001558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902467624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mark David Ruiz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669418554 PECOS PAC ID: 0941228654 Enrollment ID: I20210409001383 |
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