Healthcare Provider Details

I. General information

NPI: 1285355214
Provider Name (Legal Business Name): BETSY RODRIGUEZ RUIZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UA MAIN CAMPUS - 1200 E UNIVERSITY BLVD
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

2080 S PORTLAND AVE
GILBERT AZ
85295-9110
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN150968
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: