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General NPI Number Information
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NPI Number | 1376094540
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Entity Type | Organization
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Legal Business Name | RUISENOR PSYCHOLOGICAL P.C.
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 501 S MCCLELLAND ST
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City | SANTA MARIA
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State | CA
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Zip | 93454-5118
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Country | US
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Telephone | 805-332-3260
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Fax | 805-332-3165
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Provider Business Mailing Address
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Address Line | 501 S MCCLELLAND ST
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City | SANTA MARIA
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State | CA
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Zip | 93454-5118
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Country | US
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Telephone | 805-332-3260
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Fax | 805-332-3165
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Authorized Official
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Title or Position | EXECUTIVE OFFICER/CLINICAL DIRECTOR
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Name | DR. DALIA MIREYA RUIZ
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Credential | PSYD LMFT
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Telephone | 805-332-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFT 81281
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License Number State | CA
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