Healthcare Provider Details

I. General information

NPI: 1386258788
Provider Name (Legal Business Name): BAO VANG RUIZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BELLE VANG RUIZ LPCC

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 THE PROMENADE N UNIT 401
LONG BEACH CA
90802-4754
US

IV. Provider business mailing address

150 THE PROMENADE N UNIT 401
LONG BEACH CA
90802-4754
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-6715
  • Fax:
Mailing address:
  • Phone: 562-231-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC18762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC18762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: