Provider Demographics
NPI:1972937845
Name:LARA-RUIZ, ELIZABETH (RDA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LARA-RUIZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14525 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3638
Mailing Address - Country:US
Mailing Address - Phone:562-272-0000
Mailing Address - Fax:562-272-2728
Practice Address - Street 1:14525 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3638
Practice Address - Country:US
Practice Address - Phone:562-272-0000
Practice Address - Fax:562-272-2728
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55443126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant