Healthcare Provider Details

I. General information

NPI: 1093565467
Provider Name (Legal Business Name): JAZMINE RUVALCAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

PO BOX 776
DOS PALOS CA
93620-0776
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-1060
  • Fax:
Mailing address:
  • Phone: 559-512-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147922
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: