Healthcare Provider Details

I. General information

NPI: 1780339499
Provider Name (Legal Business Name): RUTH TIMA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH TIMA LVN

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 S KINGSLEY DR APT 304
LOS ANGELES CA
90005-4342
US

IV. Provider business mailing address

868 S KINGSLEY DR APT 304
LOS ANGELES CA
90005-4342
US

V. Phone/Fax

Practice location:
  • Phone: 213-326-7452
  • Fax:
Mailing address:
  • Phone: 213-326-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number718257
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number718257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: