Basic Information
| Provider Information | |||||||||
| NPI: | 1902150881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | NATALIA | ||||||||
| MiddleName: | LUZ | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3002 FUENTE DEL ORO | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059525073 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2180 JOHNSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054737060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2012 | ||||||||
| LastUpdateDate: | 10/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 30808 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.