Provider Demographics
NPI:1417403478
Name:RIVERO-RUIZ, LEIDY Y (RN)
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:Y
Last Name:RIVERO-RUIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TULIP GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1814
Mailing Address - Country:US
Mailing Address - Phone:631-645-2174
Mailing Address - Fax:
Practice Address - Street 1:3 TULIP GROVE DR
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1814
Practice Address - Country:US
Practice Address - Phone:631-645-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse