Healthcare Provider Details

I. General information

NPI: 1336964212
Provider Name (Legal Business Name): MARIA VIRGINIA RUANO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 255
SOUTH PASADENA CA
91030-2695
US

IV. Provider business mailing address

941 CHEHALEM RD
LA CANADA CA
91011-2504
US

V. Phone/Fax

Practice location:
  • Phone: 626-737-6735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: