Provider Demographics
NPI:1952641722
Name:RUIZ, DIANA IVELISSE (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:IVELISSE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:IVELISSE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11410 SW 245TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11410 SW 245TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4664
Practice Address - Country:US
Practice Address - Phone:305-790-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9316150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse