Healthcare Provider Details

I. General information

NPI: 1316798002
Provider Name (Legal Business Name): EMMA RUIZ MSW , PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20185 SAN MIGUEL AVE
CASTRO VALLEY CA
94546-4209
US

IV. Provider business mailing address

20185 SAN MIGUEL AVE
CASTRO VALLEY CA
94546-4209
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-1919
  • Fax:
Mailing address:
  • Phone: 510-537-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number68974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: