Healthcare Provider Details

I. General information

NPI: 1912387044
Provider Name (Legal Business Name): DIANA PAOLA RUIZ MONROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 07/24/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 W MISSOURI AVE
PHOENIX AZ
85019-2133
US

IV. Provider business mailing address

1830 W HEATHERBRAE DR
PHOENIX AZ
85015-4744
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-0281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA9389
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP15476
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: