Healthcare Provider Details

I. General information

NPI: 1740061266
Provider Name (Legal Business Name): RUTH PHILOMENA INACAY WAIVEREDPSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3894 E GETTYSBURG AVE
FRESNO CA
93726-0901
US

IV. Provider business mailing address

1814 SHERMAN ST
SELMA CA
93662-3429
US

V. Phone/Fax

Practice location:
  • Phone: 559-454-0822
  • Fax:
Mailing address:
  • Phone: 619-715-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: