Healthcare Provider Details

I. General information

NPI: 1689007098
Provider Name (Legal Business Name): GINA RUIZ NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ALA MOANA BLVD STE 1
HONOLULU HI
96814-4262
US

IV. Provider business mailing address

1330 ALA MOANA BLVD STE 1
HONOLULU HI
96814-4262
US

V. Phone/Fax

Practice location:
  • Phone: 808-589-1829
  • Fax: 808-589-2610
Mailing address:
  • Phone: 808-585-1424
  • Fax: 808-585-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number501
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: