Healthcare Provider Details

I. General information

NPI: 1376113720
Provider Name (Legal Business Name): LATOYA MOREHEAD-RUFF BSN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 W VIRGINIA AVE
PHOENIX AZ
85035-1814
US

IV. Provider business mailing address

5421 W VIRGINIA AVE
PHOENIX AZ
85035-1814
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-4900
  • Fax:
Mailing address:
  • Phone: 623-521-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: