Healthcare Provider Details

I. General information

NPI: 1205356136
Provider Name (Legal Business Name): ANGELA M RUKULE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HODENCAMP RD STE 103
THOUSAND OAKS CA
91360-5833
US

IV. Provider business mailing address

5235 MISSION OAKS BLVD # 610
CAMARILLO CA
93012-5400
US

V. Phone/Fax

Practice location:
  • Phone: 805-914-5063
  • Fax:
Mailing address:
  • Phone: 805-914-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMVO23092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: