Active NPI
Dalila Isabel Ruiz, RD
- Registered Dietitian
- Riverside, CA
National Provider Identifier
1114439155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86040318
- Practice address
- 11801 Pierce St Ste 200
Riverside, CA 92505-4400 - Phone
- (509) 868-0488
- Fax
- (844) 605-1799
- NPI assigned
- Oct 31, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 86040318 | CA | |
| Registered Dietitian | 133V00000X | 86040318 | CA | Primary |
Addresses
Primary practice location
11801 Pierce St Ste 200
Riverside, CA 92505-4400
Mailing address
4610 W Park View LN
Spokane, WA 99205-7719
Phone (509) 868-0488
Other practice location 1
4610 W Park View Ln
Spokane, WA 99205-7719
Phone (509) 868-0488
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA445386 | Medicaid | CA |
Other names 1
- Mrs. Dalila Isabel Ruiz de Kock
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210112000812 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 0547673501 | Practice locations: Riverside, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86040318 | CA | MD | Registered Dietitian |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678406400000",
"number": "1114439155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4610 W PARK VIEW LN",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992057719",
"telephone_number": "509-868-0488",
"fax_number": "844-605-1799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 PIERCE ST STE 200",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925054400",
"telephone_number": "509-868-0488",
"fax_number": "844-605-1799"
}
],
"practiceLocations": [
{
"address_1": "4610 W Park View Ln",
"address_purpose": "LOCATION",
"city": "Spokane",
"state": "WA",
"postal_code": "992057719",
"country_code": "US",
"telephone_number": "509-868-0488",
"fax_number": "844-605-1799",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUIZ",
"first_name": "DALILA",
"middle_name": "ISABEL",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-31",
"last_updated": "2023-03-10",
"certification_date": "2023-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "CA",
"license": "86040318",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86040318",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CA445386",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DALILA",
"last_name": "RUIZ DE KOCK",
"middle_name": "ISABEL",
"prefix": "MRS.",
"credential": "RD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.