Healthcare Provider Details

I. General information

NPI: 1912680257
Provider Name (Legal Business Name): JACKELINE BALAREZO-RUVALCABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 09/10/2026
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 OLD IRONSIDES DR STE 304
SANTA CLARA CA
95054
US

IV. Provider business mailing address

15766 LA FORGE ST # 155
WHITTIER CA
90603-2334
US

V. Phone/Fax

Practice location:
  • Phone: 626-899-0213
  • 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 Number
License Number State

VIII. Authorized Official

Name: MRS. JACKELINE BALAREZO- RUVALCABA
Title or Position: PRESIDENT
Credential: LCSW
Phone: 818-644-9953