Healthcare Provider Details

I. General information

NPI: 1043717416
Provider Name (Legal Business Name): MR. JONATHAN JUAREZ-RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 AUBURN BLVD STE 3
CITRUS HEIGHTS CA
95610-0391
US

IV. Provider business mailing address

1111 J ST APT 112
DAVIS CA
95616-2162
US

V. Phone/Fax

Practice location:
  • Phone: 916-512-8420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT130550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: