Healthcare Provider Details

I. General information

NPI: 1780260612
Provider Name (Legal Business Name): RUBY AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 400
GARDENA CA
90248-4223
US

IV. Provider business mailing address

1501 W CAMERON AVE STE 215
WEST COVINA CA
91790-2724
US

V. Phone/Fax

Practice location:
  • Phone: 323-302-9997
  • Fax: 818-736-4189
Mailing address:
  • Phone: 323-302-9997
  • Fax: 818-736-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: