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General NPI Number Information
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NPI Number | 1700937778
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Entity Type | Organization
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Legal Business Name | AMANDA RUIZ, M.D., INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD THALIANS, SUITE E123-D
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 858-344-8016
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1309
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City | STUDIO CITY
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State | CA
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Zip | 92138-7972
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Country | US
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Telephone | 858-344-8016
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AMANDA RUIZ GRAVES
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Credential | M.D.
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Telephone | 858-344-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | A67430
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A67430
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License Number State | CA
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