Healthcare Provider Details

I. General information

NPI: 1912820150
Provider Name (Legal Business Name): JADE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 E SHIELDS AVE
FRESNO CA
93726-7220
US

IV. Provider business mailing address

3703 W MYRTLE CT
VISALIA CA
93277-1712
US

V. Phone/Fax

Practice location:
  • Phone: 559-240-9206
  • Fax:
Mailing address:
  • Phone: 559-794-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: