Provider Demographics
NPI:1184207771
Name:KUTILEK, RUVY ROSE DAYRIT (NP)
Entity Type:Individual
Prefix:
First Name:RUVY ROSE
Middle Name:DAYRIT
Last Name:KUTILEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 S BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2414
Mailing Address - Country:US
Mailing Address - Phone:213-448-6308
Mailing Address - Fax:
Practice Address - Street 1:2642 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2414
Practice Address - Country:US
Practice Address - Phone:213-448-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015661363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care