Individual
ROBERTO RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18818 OUTER HWY 18, APPLE VALLEY, CA 92307-2323
(760) 995-8868
Mailing address
2633 111TH ST, LYNWOOD, CA 90262-1713
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
16627
CA
101YP2500X
Professional Counselor
—
—
225400000X
Rehabilitation Practitioner
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043718737
TRAINEE
—
05
—
1043718737
—
CA
Enumeration date
01/27/2018
Last updated
09/04/2024
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