=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336410380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH OSCAR MARRUJO CDACC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2012
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 W SANTA ANA BLVD STE 109
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-4582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-667-7926
-----------------------------------------------------
Fax | 714-667-7918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 W SANTA ANA BLVD STE 109
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-4582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-667-7926
-----------------------------------------------------
Fax | 714-667-7918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 5382
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------