Healthcare Provider Details

I. General information

NPI: 1285440107
Provider Name (Legal Business Name): RUBEN OLMEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N. MONTEBELLO BLVD SUITE D
MONTEBELLO CA
90640
US

IV. Provider business mailing address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0080
  • Fax:
Mailing address:
  • Phone: 213-989-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: