Healthcare Provider Details

I. General information

NPI: 1891112595
Provider Name (Legal Business Name): DOLORES RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 PAINTER AVE
WHITTIER CA
90605-2729
US

IV. Provider business mailing address

13135 BARTON RD
WHITTIER CA
90605-2757
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-9436
  • Fax:
Mailing address:
  • Phone: 562-903-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1111051-E-02-71/2790
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11110712.51-E02-71/2
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: