Provider Demographics
NPI:1114439155
Name:RUIZ, DALILA ISABEL (RD)
Entity type:Individual
Prefix:MRS
First Name:DALILA
Middle Name:ISABEL
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:DALILA
Other - Middle Name:ISABEL
Other - Last Name:RUIZ DE KOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:4610 W PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7719
Mailing Address - Country:US
Mailing Address - Phone:509-868-0488
Mailing Address - Fax:844-605-1799
Practice Address - Street 1:11801 PIERCE ST STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-4400
Practice Address - Country:US
Practice Address - Phone:509-868-0488
Practice Address - Fax:844-605-1799
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86040318133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA445386Medicaid