Provider Demographics
NPI:1588180954
Name:RUIZ, DALILA ELVIRA (RNCM)
Entity type:Individual
Prefix:MRS
First Name:DALILA
Middle Name:ELVIRA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RNCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 N ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1541
Mailing Address - Country:US
Mailing Address - Phone:818-272-6051
Mailing Address - Fax:
Practice Address - Street 1:1701 CESAR CHAVEZ AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-725-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531470163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA450719563OtherUS PASSPORT
CAN9470078OtherDRIVER LICENSE
CA$$$$$$$$$OtherSOCIAL SECURITY