Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 58569 | MA |
N | 2080P0201X | Pediatric Allergist | 58569 | MA |
Y | 2080P0208X | Pediatric Infectious Diseases | 58569 | MA |
NPI | 1487638516 |
---|---|
Provider Name | Dr. Katherine F Ruiz-De-Luzuriaga |
First Address | Boston, MA 02241-0001 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110045838A | (05) | MA |
E44219 | (02) | MA |
J0747601 | MEDICARE (01) | MA |