Provider Demographics
NPI:1477388965
Name:RUIZ DUQUE, ROCIO DEL VALLE (SA-C)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:DEL VALLE
Last Name:RUIZ DUQUE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2467
Mailing Address - Country:US
Mailing Address - Phone:319-800-3211
Mailing Address - Fax:
Practice Address - Street 1:18761 CHESTNUT CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9501
Practice Address - Country:US
Practice Address - Phone:786-448-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000815363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical