Healthcare Provider Details

I. General information

NPI: 1972147726
Provider Name (Legal Business Name): RAKIYA LISETTE RUIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 MADRONA AVE STE C100
TORRANCE CA
90503-4915
US

IV. Provider business mailing address

5701 TRUXTUN AVE STE 220
BAKERSFIELD CA
93309-0402
US

V. Phone/Fax

Practice location:
  • Phone: 213-642-4611
  • Fax:
Mailing address:
  • Phone: 808-987-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW109820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: