Provider Demographics
NPI:1902489610
Name:SOTO RUIZ, LILIANA (LVN)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:SOTO RUIZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S TUSTIN SR
Mailing Address - Street 2:BUILDING D
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN SR
Practice Address - Street 2:BUILDING D
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866
Practice Address - Country:US
Practice Address - Phone:714-289-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713691164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA713691OtherBVNPT