Healthcare Provider Details

I. General information

NPI: 1356212674
Provider Name (Legal Business Name): DIEGO RUIZVELASCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W STANLEY AVE
VENTURA CA
93001-1313
US

IV. Provider business mailing address

732 WALNUT DR
OXNARD CA
93036-1434
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: