Healthcare Provider Details

I. General information

NPI: 1790621860
Provider Name (Legal Business Name): RUBY'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W ARBOR AVE
TRACY CA
95304-9452
US

IV. Provider business mailing address

20880 BAKER RD
CASTRO VALLEY CA
94546-5729
US

V. Phone/Fax

Practice location:
  • Phone: 916-878-9458
  • Fax:
Mailing address:
  • Phone: 916-878-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOPHORA ACHESON
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 510-519-8083