Healthcare Provider Details

I. General information

NPI: 1033490370
Provider Name (Legal Business Name): OSCAR RUIZ BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 E DYER RD STE 135
SANTA ANA CA
92705-5643
US

IV. Provider business mailing address

1231 E DYER RD STE 135
SANTA ANA CA
92705-5643
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-0488
  • Fax:
Mailing address:
  • Phone: 949-250-0488
  • Fax: 714-659-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: