Provider Demographics
NPI:1992196091
Name:RUIZ-MORALES, ELVA (RN)
Entity Type:Individual
Prefix:MISS
First Name:ELVA
Middle Name:
Last Name:RUIZ-MORALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELVA
Other - Middle Name:
Other - Last Name:BOUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:860 9TH AVE
Mailing Address - Street 2:APT. 4FS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4449
Mailing Address - Country:US
Mailing Address - Phone:917-434-9900
Mailing Address - Fax:
Practice Address - Street 1:860 9TH AVE
Practice Address - Street 2:APT. 4FS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4449
Practice Address - Country:US
Practice Address - Phone:917-434-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse