MEDICARE: MS. RUBY CHAIREZ DI

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1821661174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUBY CHAIREZ DI

Provider Business Mailing Address
First Line	:	2509 COGSWELL RD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 COGSWELL RD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-3738
Country	:	US
Telephone Number	:	818-844-3376
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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