Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 31349 | CA |
NPI | 1003104407 |
---|---|
Provider Name | Roman Ruiz |
First Address | Santa Clarita, CA 91350-2947 |
Second Address | Santa Clarita, CA 91350-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 03/06/2014 |