Healthcare Provider Details

I. General information

NPI: 1972177301
Provider Name (Legal Business Name): SULEIKA RUIZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 EVARTS ST NE
WASHINGTON DC
20018-2029
US

IV. Provider business mailing address

5712 SILK TREE DR
RIVERDALE MD
20737-3512
US

V. Phone/Fax

Practice location:
  • Phone: 202-213-6423
  • Fax:
Mailing address:
  • Phone: 787-232-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9551398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number071005
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: