Healthcare Provider Details

I. General information

NPI: 1922902949
Provider Name (Legal Business Name): RUBEN RETAMOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 MARINE VIEW AVE, DEL MAR, CA
DEL MAR CA
92014
US

IV. Provider business mailing address

455 MARINE VIEW AVE, DEL MAR, CA
DEL MAR CA
92014
US

V. Phone/Fax

Practice location:
  • Phone: 909-483-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: