Healthcare Provider Details

I. General information

NPI: 1376039701
Provider Name (Legal Business Name): RUBY RUGAMA GARDEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 08/08/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FORD ST
OAKLAND CA
94601-2114
US

IV. Provider business mailing address

3419 SAVANNAH LN APT 1921
WEST SACRAMENTO CA
95691-5987
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-3770
  • Fax:
Mailing address:
  • Phone: 916-475-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: