Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003279365 |
---|---|
Provider Name | Mr. Cullen Samuel Ruiz |
First Address | San Francisco, CA 94116-2923 |
Second Address | San Francisco, CA 94116-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2016 |
Last Update Date | 04/04/2017 |