Healthcare Provider Details

I. General information

NPI: 1235797036
Provider Name (Legal Business Name): RUTH HARO PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NICOLET AVE UNIT 1
FREMONT CA
94536-3536
US

IV. Provider business mailing address

3400 NICOLET AVE UNIT 1
FREMONT CA
94536-3536
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-5940
  • Fax:
Mailing address:
  • Phone: 510-797-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number250209445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: