Provider Demographics
NPI:1295387264
Name:RUIZ, STEPHANIE TATIANA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TATIANA
Last Name:RUIZ
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 1:1039 W 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5231
Mailing Address - Country:US
Mailing Address - Phone:323-482-4885
Mailing Address - Fax:
Practice Address - Street 1:3424 MOTOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4710
Practice Address - Country:US
Practice Address - Phone:424-672-6700
Practice Address - Fax:424-672-6819
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst