Healthcare Provider Details

I. General information

NPI: 1194858860
Provider Name (Legal Business Name): JACKELINE BALAREZO- RUVALCABA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 OLD IRONSIDES DR STE 304
SANTA CLARA CA
95054-1846
US

IV. Provider business mailing address

15766 LA FORGE ST # 222
WHITTIER CA
90603-2334
US

V. Phone/Fax

Practice location:
  • Phone: 818-644-9953
  • Fax:
Mailing address:
  • Phone: 818-644-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number817776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: