Provider Demographics
NPI:1083751853
Name:SHAFFER, RUTH EVA (PSYD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:EVA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 S CATALINA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5511
Mailing Address - Country:US
Mailing Address - Phone:310-540-6045
Mailing Address - Fax:310-540-1811
Practice Address - Street 1:1820 S CATALINA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5511
Practice Address - Country:US
Practice Address - Phone:310-540-6045
Practice Address - Fax:310-540-1811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13298103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13298Medicare ID - Type Unspecified