Healthcare Provider Details

I. General information

NPI: 1003730094
Provider Name (Legal Business Name): SELINA RUIZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15472 CHEMICAL LN
HUNTINGTON BEACH CA
92649-1220
US

IV. Provider business mailing address

4841 HEIL AVE APT 85
HUNTINGTON BEACH CA
92649-3238
US

V. Phone/Fax

Practice location:
  • Phone: 714-251-6511
  • Fax: 714-251-6511
Mailing address:
  • Phone: 714-747-8916
  • Fax: 714-747-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: