Provider Demographics
NPI:1417234832
Name:AYUBA, RALIAT (LPN)
Entity Type:Individual
Prefix:MISS
First Name:RALIAT
Middle Name:
Last Name:AYUBA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 WASHINGTON AVE
Mailing Address - Street 2:APT. 6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5593
Mailing Address - Country:US
Mailing Address - Phone:347-784-2528
Mailing Address - Fax:
Practice Address - Street 1:1138 WASHINGTON AVE
Practice Address - Street 2:APT. 6C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5593
Practice Address - Country:US
Practice Address - Phone:347-784-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308177-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse