Healthcare Provider Details

I. General information

NPI: 1376974550
Provider Name (Legal Business Name): ESMERALDA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE SUITE I
MODESTO CA
95350-3839
US

IV. Provider business mailing address

5815 STODDARD RD STE 600
MODESTO CA
95356-9041
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax: 209-526-0908
Mailing address:
  • Phone: 209-543-1874
  • Fax: 209-543-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: