Healthcare Provider Details

I. General information

NPI: 1740615954
Provider Name (Legal Business Name): BORIS A RUIZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

9963 RUTLAND AVE
WHITTIER CA
90605-3330
US

V. Phone/Fax

Practice location:
  • Phone: 213-238-2483
  • Fax:
Mailing address:
  • Phone: 562-260-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW93684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: