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General NPI Number Information
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NPI Number | 1043718737
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Entity Type | Individual
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Provider Name | ROBERTO RUIZ
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Gender | Male
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Dates
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Enumeration Date | 01/27/2018
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 18818 OUTER HWY 18
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2323
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Country | US
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Telephone | 760-995-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 2633 111TH ST
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City | LYNWOOD
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State | CA
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Zip | 90262-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 16627
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License Number State | CA
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