Healthcare Provider Details

I. General information

NPI: 1760677934
Provider Name (Legal Business Name): RITA P RUIZ-MADERO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS RITA RUIZ

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GEER RD
TURLOCK CA
95382
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-664-8044
  • Fax:
Mailing address:
  • Phone: 209-525-7339
  • Fax: 209-558-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: