Healthcare Provider Details

I. General information

NPI: 1912024878
Provider Name (Legal Business Name): MRS. DIANA RUANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 ALLEN AVE
ALTADENA CA
91001-3424
US

IV. Provider business mailing address

2046 N ALLEN AVE
ALTADENA CA
91001-2436
US

V. Phone/Fax

Practice location:
  • Phone: 323-600-5879
  • Fax:
Mailing address:
  • Phone: 323-600-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: