Healthcare Provider Details

I. General information

NPI: 1932465218
Provider Name (Legal Business Name): LISA MARGARET RUEDA PSYCHOLOGIST DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ANGELES VISTA BLVD
LOS ANGELES CA
90043
US

IV. Provider business mailing address

5300 ANGELES VISTA BLVD
LOS ANGELES CA
90043
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-4555
  • Fax: 323-295-3021
Mailing address:
  • Phone: 323-295-4555
  • Fax: 323-295-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: