Healthcare Provider Details

I. General information

NPI: 1114439155
Provider Name (Legal Business Name): DALILA ISABEL RUIZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DALILA ISABEL RUIZ DE KOCK RD

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST STE 200
RIVERSIDE CA
92505-4400
US

IV. Provider business mailing address

4610 W PARK VIEW LN
SPOKANE WA
99205-7719
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-0488
  • Fax: 844-605-1799
Mailing address:
  • Phone: 509-868-0488
  • Fax: 844-605-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number86040318
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86040318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: