1457688111 NPI number — DR. RUTH ELLEN DE LARIOS RUTH DE LARIOS

Table of content: DR. RUTH ELLEN DE LARIOS RUTH DE LARIOS (NPI 1457688111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457688111 NPI number — DR. RUTH ELLEN DE LARIOS RUTH DE LARIOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LARIOS
Provider First Name:
RUTH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RUTH DE LARIOS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LARIOS
Provider Other First Name:
RUTH
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457688111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1068 S 7TH AVE
Provider Second Line Business Mailing Address:
APT. 8
Provider Business Mailing Address City Name:
AVENAL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93204-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-386-0722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 KINGS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-386-0388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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