Provider Demographics
NPI:1225703499
Name:DEAN, SUYAMA RUTH (LVN)
Entity Type:Individual
Prefix:
First Name:SUYAMA
Middle Name:RUTH
Last Name:DEAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4186 LEIMERT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3820
Mailing Address - Country:US
Mailing Address - Phone:213-370-7114
Mailing Address - Fax:
Practice Address - Street 1:4265 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2324
Practice Address - Country:US
Practice Address - Phone:213-841-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265609164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse