Healthcare Provider Details

I. General information

NPI: 1245471945
Provider Name (Legal Business Name): LAURA RUANO-GARCIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FIRST STREET
BRENTWOOD CA
94513-1430
US

IV. Provider business mailing address

815 1ST ST STE 5
BRENTWOOD CA
94513-1165
US

V. Phone/Fax

Practice location:
  • Phone: 559-827-3957
  • Fax:
Mailing address:
  • Phone: 559-827-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: