Provider Demographics
NPI:1679393920
Name:DERVIL, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:DERVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 NW 73RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-3624
Mailing Address - Country:US
Mailing Address - Phone:786-764-7027
Mailing Address - Fax:
Practice Address - Street 1:857 NW 73RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-3624
Practice Address - Country:US
Practice Address - Phone:786-764-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician