Healthcare Provider Details

I. General information

NPI: 1497618102
Provider Name (Legal Business Name): RIA RUPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 SEPULVEDA BLVD STE 180
MISSION HILLS CA
91345-2654
US

IV. Provider business mailing address

10200 SEPULVEDA BLVD STE 180
MISSION HILLS CA
91345-2654
US

V. Phone/Fax

Practice location:
  • Phone: 818-672-6338
  • Fax:
Mailing address:
  • Phone: 818-672-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW26945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: