Basic Information
| Provider Information | |||||||||
| NPI: | 1669887857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ-OCHOA | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUIZ DE MARQUEZ | ||||||||
| OtherFirstName: | CARMEN | ||||||||
| OtherMiddleName: | MARIA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25620 REED DR | ||||||||
| Address2: | |||||||||
| City: | LOMITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907172403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102101973 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6101 W CENTINELA AVE STE 380 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377827 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-15224 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.