Healthcare Provider Details

I. General information

NPI: 1588180954
Provider Name (Legal Business Name): DALILA ELVIRA RUIZ RN.CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CESAR CHAVEZ AVENUE
LOS ANGELES CA
90033
US

IV. Provider business mailing address

922 N ORCHARD DR
BURBANK CA
91506-1541
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-8751
  • Fax:
Mailing address:
  • Phone: 818-272-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number531470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: