Basic Information
| Provider Information | |||||||||
| NPI: | 1588180954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | DALILA | ||||||||
| MiddleName: | ELVIRA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN.CM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 922 N ORCHARD DR | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915061541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182726051 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 CESAR CHAVEZ AVENUE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237258751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 531470 | CA | Y | Nursing Service Providers | Registered Nurse | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 450719563 | 01 | CA | US PASSPORT | OTHER | N9470078 | 01 | CA | DRIVER LICENSE | OTHER |