MEDICARE: BAO VANG RUIZ LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC18762	CA
2	101YM0800X	Mental Health Counselor	LPCC18762	CA

General Provider Information

NPI Number	:	1386258788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAO VANG RUIZ LPCC

Provider Business Mailing Address
First Line	:	150 THE PROMENADE N UNIT 401
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4754
Country	:	US
Telephone Number	:	562-231-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 THE PROMENADE N UNIT 401
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4754
Country	:	US
Telephone Number	:	562-231-6715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/17/2025

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