Provider Demographics
NPI:1194466409
Name:RUANO, MELISSA EILLEEN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:EILLEEN
Last Name:RUANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 RESERVOIR DR STE 204-A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5134
Mailing Address - Country:US
Mailing Address - Phone:619-822-1800
Mailing Address - Fax:619-839-3872
Practice Address - Street 1:5555 RESERVOIR DR STE 204-A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5134
Practice Address - Country:US
Practice Address - Phone:619-822-1800
Practice Address - Fax:619-839-3872
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC11729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional