Healthcare Provider Details

I. General information

NPI: 1689889743
Provider Name (Legal Business Name): MARIA ASCENSION RUNCIMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SOQUEL DR STE 650
SOQUEL CA
95073-2862
US

IV. Provider business mailing address

800 KATIE LN
CORRALITOS CA
95076-0364
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2494
  • Fax: 831-393-3115
Mailing address:
  • Phone: 831-728-2494
  • Fax: 831-393-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: