Healthcare Provider Details

I. General information

NPI: 1972171486
Provider Name (Legal Business Name): LAURA GISELLE RUIZ-BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PARKCENTRE WAY
NAMPA ID
83651-1745
US

IV. Provider business mailing address

904 N ILLINOIS AVE
CALDWELL ID
83605-2411
US

V. Phone/Fax

Practice location:
  • Phone: 208-442-7791
  • Fax:
Mailing address:
  • Phone: 208-695-8599
  • Fax: 208-695-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911380
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: