Healthcare Provider Details

I. General information

NPI: 1124584180
Provider Name (Legal Business Name): MS. JENNIFER RUVALCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 MYERS ST
RIVERSIDE CA
92503-5525
US

IV. Provider business mailing address

PO BOX 310385
FONTANA CA
92331-0385
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6895
  • Fax:
Mailing address:
  • Phone: 951-514-9183
  • Fax:

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: