=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376663179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSALBA TRIAS-RUIZ PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7032 COMSTOCK AVE STE 200
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-1390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-636-5442
-----------------------------------------------------
Fax | 562-907-6797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20620 GARTEL DR
-----------------------------------------------------
City | WALNUT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-636-5442
-----------------------------------------------------
Fax | 562-696-3531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY15380
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------