Basic Information
| Provider Information | |||||||||
| NPI: | 1104199058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 IOOF AVE | ||||||||
| Address2: | |||||||||
| City: | GILROY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950205204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088462100 | ||||||||
| FaxNumber: | 4088462489 | ||||||||
| Practice Location | |||||||||
| Address1: | 484 E SAN FERNANDO ST | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951123513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082930422 | ||||||||
| FaxNumber: | 4082772474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF# 80624 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | F2288679 | 01 | CA | CALIFORNIA ID | OTHER |