Healthcare Provider Details

I. General information

NPI: 1689578205
Provider Name (Legal Business Name): RUBY OLACIO LMFT/PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W ALLEN AVE
SAN DIMAS CA
91773-1437
US

IV. Provider business mailing address

1629 HOLLY OAK ST
LA VERNE CA
91750-3914
US

V. Phone/Fax

Practice location:
  • Phone: 909-971-8200
  • Fax:
Mailing address:
  • Phone: 909-971-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: