Healthcare Provider Details

I. General information

NPI: 1225703499
Provider Name (Legal Business Name): SUYAMA RUTH DEAN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 S NORMANDIE AVE
LOS ANGELES CA
90037-2324
US

IV. Provider business mailing address

4186 LEIMERT BLVD
LOS ANGELES CA
90008-3820
US

V. Phone/Fax

Practice location:
  • Phone: 213-841-1325
  • Fax:
Mailing address:
  • Phone: 213-370-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number265609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: