Healthcare Provider Details

I. General information

NPI: 1174454979
Provider Name (Legal Business Name): AMANDA LOUISE RUIZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 30TH ST
OMAHA NE
68131-2100
US

IV. Provider business mailing address

40124 VILLAGE RD APT 1913
TEMECULA CA
92591-3539
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-5087
  • Fax:
Mailing address:
  • Phone: 951-306-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP17477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: