Basic Information
| Provider Information | |||||||||
| NPI: | 1891355707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUVALCABA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | TRINIDAD | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13835 WEIDNER ST | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913313551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182701421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 237 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912033526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185479544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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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 | 101YM0800X | ASW89801 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.