Basic Information
| Provider Information | |||||||||
| NPI: | 1477047371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | CARLOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 ENCINAL ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950602178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314691700 | ||||||||
| FaxNumber: | 8314251905 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 RIGG ST | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950604203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314233890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2018 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1244120217 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | XEH906388190 | 01 | CA | BLUE CALIFORNIA | OTHER |