Healthcare Provider Details

I. General information

NPI: 1053777607
Provider Name (Legal Business Name): MR. RALPH CLIFFORD VROOMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALLERTON ST FL 2
REDWOOD CITY CA
94063-1519
US

IV. Provider business mailing address

421 6TH AVE
MENLO PARK CA
94025-1840
US

V. Phone/Fax

Practice location:
  • Phone: 650-599-9955
  • Fax:
Mailing address:
  • Phone: 650-771-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: