Healthcare Provider Details

I. General information

NPI: 1619574076
Provider Name (Legal Business Name): MAYA CHRISTINE RUANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 KUHN DR STE 110
CHULA VISTA CA
91914-3551
US

IV. Provider business mailing address

2337 EASTRIDGE LOOP
CHULA VISTA CA
91915-1111
US

V. Phone/Fax

Practice location:
  • Phone: 619-864-7070
  • Fax:
Mailing address:
  • Phone: 619-770-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: