Healthcare Provider Details

I. General information

NPI: 1487724985
Provider Name (Legal Business Name): RUBY L RICHARDS MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-9073
  • Fax:
Mailing address:
  • Phone: 714-680-9073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: