Healthcare Provider Details

I. General information

NPI: 1518821578
Provider Name (Legal Business Name): ALYSSA CHRISTINE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STEIN PLAZA
LOS ANGELES CA
90095-5631
US

IV. Provider business mailing address

437 GREENDALE DR
LA PUENTE CA
91746-2744
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5000
  • Fax:
Mailing address:
  • Phone: 626-991-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number23509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: