Provider Demographics
NPI:1851154751
Name:SIERRA ANGEL, RUTH VIVIAN
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:VIVIAN
Last Name:SIERRA ANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27345 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8854
Mailing Address - Country:US
Mailing Address - Phone:786-241-3005
Mailing Address - Fax:
Practice Address - Street 1:27345 SW 142ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8854
Practice Address - Country:US
Practice Address - Phone:786-241-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician