Provider Demographics
NPI:1972229177
Name:IKUOMOLA, RUTH EILEEN (CPT, MLA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:EILEEN
Last Name:IKUOMOLA
Suffix:
Gender:F
Credentials:CPT, MLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2318
Mailing Address - Country:US
Mailing Address - Phone:520-221-9951
Mailing Address - Fax:
Practice Address - Street 1:621 E NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2318
Practice Address - Country:US
Practice Address - Phone:520-221-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy