MEDICARE: SUYAMA RUTH DEAN LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	265609	CA

General Provider Information

NPI Number	:	1225703499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUYAMA RUTH DEAN LVN

Provider Business Mailing Address
First Line	:	4186 LEIMERT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3820
Country	:	US
Telephone Number	:	213-370-7114
Fax Number	:

Provider Business Practice Location Address
First Line	:	4265 S NORMANDIE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2324
Country	:	US
Telephone Number	:	213-841-1325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	08/10/2021

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Directions to “ SUYAMA RUTH DEAN LVN” Practice Location

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