Healthcare Provider Details

I. General information

NPI: 1043490204
Provider Name (Legal Business Name): RUBEN OJEDA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 N H ST
LOMPOC CA
93436-4519
US

IV. Provider business mailing address

646 N H ST
LOMPOC CA
93436-4519
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-1943
  • Fax: 805-865-1954
Mailing address:
  • Phone: 805-865-1943
  • Fax: 805-865-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: