Healthcare Provider Details

I. General information

NPI: 1194254615
Provider Name (Legal Business Name): RUI ZHE SONG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENA SONG

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 GALE AVE STE 154
CITY OF INDUSTRY CA
91748-1342
US

IV. Provider business mailing address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-0300
  • Fax:
Mailing address:
  • Phone: 626-793-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35841
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: