Healthcare Provider Details

I. General information

NPI: 1811567720
Provider Name (Legal Business Name): BRANDON RUVALCABA APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 BRADENTON AVE STE 130
DUBLIN OH
43017-3551
US

IV. Provider business mailing address

4995 BRADENTON AVE STE 130
DUBLIN OH
43017-3551
US

V. Phone/Fax

Practice location:
  • Phone: 614-580-6917
  • Fax:
Mailing address:
  • Phone: 614-580-6917
  • Fax: 614-368-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN.471569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: