Healthcare Provider Details

I. General information

NPI: 1376001297
Provider Name (Legal Business Name): RUBY CHAVEZ MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 BANYAN CT
CERES CA
95307-1907
US

IV. Provider business mailing address

1604 ALMADOR TER
ATWATER CA
95301-4202
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-2088
  • Fax:
Mailing address:
  • Phone: 209-489-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: