Healthcare Provider Details

I. General information

NPI: 1124918032
Provider Name (Legal Business Name): ADILENE RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

1910 S UNION ST UNIT 5019
ANAHEIM CA
92805-7421
US

V. Phone/Fax

Practice location:
  • Phone: 657-339-2799
  • Fax:
Mailing address:
  • Phone: 925-858-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: