Basic Information
Provider Information
NPI: 1497835581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAVARRO
FirstName: RUBY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2205 HALLADAY ST
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927072907
CountryCode: US
TelephoneNumber: 7145176353
FaxNumber:  
Practice Location
Address1: 4000 W METROPOLITAN DR STE 401
Address2:  
City: ORANGE
State: CA
PostalCode: 928683506
CountryCode: US
TelephoneNumber: 7145176353
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2006
LastUpdateDate: 06/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X CAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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