MEDICARE: GUADALUPE LIZBETH ALANIS RUIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1134755473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE LIZBETH ALANIS RUIZ

Provider Business Mailing Address
First Line	:	16501 VENTURA BLVD
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-2007
Country	:	US
Telephone Number	:	818-356-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	23450 NEWHALL AVE SPC 61
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-3138
Country	:	US
Telephone Number	:	661-753-4224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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