Healthcare Provider Details

I. General information

NPI: 1275186967
Provider Name (Legal Business Name): STELLA RUVALCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ROYALTY DR
POMONA CA
91767-3032
US

IV. Provider business mailing address

1900 ROYALTY DR
POMONA CA
91767-3032
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6131
  • Fax: 909-865-9281
Mailing address:
  • Phone: 909-623-6131
  • Fax: 909-865-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: