Healthcare Provider Details

I. General information

NPI: 1053241489
Provider Name (Legal Business Name): TINA RUIZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 N AVENUE 50
LOS ANGELES CA
90042-3205
US

IV. Provider business mailing address

2042 ESCARPA DR
LOS ANGELES CA
90041-3017
US

V. Phone/Fax

Practice location:
  • Phone: 310-426-2932
  • Fax:
Mailing address:
  • Phone: 877-900-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: