Provider Demographics
NPI:1114554136
Name:DEL TORO RUIZ, CASSANDRA ARLENE (RADT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ARLENE
Last Name:DEL TORO RUIZ
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:ARLENE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADT
Mailing Address - Street 1:2403 YREKA AVE # 15
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4466
Mailing Address - Country:US
Mailing Address - Phone:916-910-3692
Mailing Address - Fax:
Practice Address - Street 1:7240 E SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2627
Practice Address - Country:US
Practice Address - Phone:916-910-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD9140390OtherLICENSE