Healthcare Provider Details

I. General information

NPI: 1134940687
Provider Name (Legal Business Name): MARYANN KAY RUIZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IHDD 1701 NE COLUMBIA ROAD
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

PO BOX 357920
SEATTLE WA
98195-7920
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9887
  • Fax:
Mailing address:
  • Phone: 206-598-3611
  • Fax: 206-598-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number61259485
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: