Healthcare Provider Details

I. General information

NPI: 1336342765
Provider Name (Legal Business Name): STEPHEN REED RUZICKA MFT MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

760 ENCINO DR
APTOS CA
95003-4871
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4538
  • Fax:
Mailing address:
  • Phone: 831-454-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: