Basic Information
| Provider Information | |||||||||
| NPI: | 1821421264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | MARIE O'BRIEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 E LOS ANGELES AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930652871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053388679 | ||||||||
| FaxNumber: | 8055796010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 E LOS ANGELES AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930652871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055824080 | ||||||||
| FaxNumber: | 8055796010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT104549 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | C1645163 | 01 | CA | CA DL | OTHER |