Healthcare Provider Details

I. General information

NPI: 1407745391
Provider Name (Legal Business Name): AHOLIBAMA RUIZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. MANCHESTER AVE SUITE 222
ORANGE CA
92868
US

IV. Provider business mailing address

10 THUNDER RUN APT 2F
IRVINE CA
92614-5421
US

V. Phone/Fax

Practice location:
  • Phone: 714-385-2909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: