Healthcare Provider Details

I. General information

NPI: 1972494441
Provider Name (Legal Business Name): SOFIA RUIZ MAIZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N SAN VICENTE BLVD STE 256
BEVERLY HILLS CA
90211-2329
US

IV. Provider business mailing address

28478 HORSESHOE CIR
SANTA CLARITA CA
91390-5707
US

V. Phone/Fax

Practice location:
  • Phone: 805-664-2116
  • Fax:
Mailing address:
  • Phone: 323-284-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC19593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: