Healthcare Provider Details

I. General information

NPI: 1962780601
Provider Name (Legal Business Name): MRS. SARAH RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH CHAMBERLAIN

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 N WHITE RD
SAN JOSE CA
95127-1439
US

IV. Provider business mailing address

438 N WHITE RD
SAN JOSE CA
95127-1439
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-6848
  • Fax: 408-937-5394
Mailing address:
  • Phone: 408-254-6848
  • Fax: 408-937-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: