Provider Demographics
NPI:1962964296
Name:SUN CITY DIETITIANS
Entity type:Organization
Organization Name:SUN CITY DIETITIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD, CDCES
Authorized Official - Phone:915-262-6192
Mailing Address - Street 1:2601 E YANDELL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3743
Mailing Address - Country:US
Mailing Address - Phone:915-262-6192
Mailing Address - Fax:833-526-6362
Practice Address - Street 1:2601 E YANDELL DR STE 104
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3743
Practice Address - Country:US
Practice Address - Phone:915-262-6192
Practice Address - Fax:833-526-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX448773801Medicaid
TX397783702Medicaid
TX453480201Medicaid
NM91582041Medicaid