Healthcare Provider Details

I. General information

NPI: 1568290963
Provider Name (Legal Business Name): NANCY RUANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33353 YUCAIPA BLVD
YUCAIPA CA
92399-2018
US

IV. Provider business mailing address

14617 ASHTON CT
MORENO VALLEY CA
92555-5741
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone: 951-591-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: