Provider Demographics
NPI:1013470111
Name:DEL RUTH, MARIA SUSANA (MSN, PHN, RN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:SUSANA
Last Name:DEL RUTH
Suffix:
Gender:F
Credentials:MSN, PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-923 OASIS STREET
Mailing Address - Street 2:PHN SUITE
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:951-202-7606
Mailing Address - Fax:
Practice Address - Street 1:47-923 OASIS STREET
Practice Address - Street 2:PHN SUITE
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:951-202-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95093249163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty