Provider Demographics
NPI:1316199045
Name:BUJANDA-MOORE, RUTH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:BUJANDA-MOORE
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 1:15321 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3700
Mailing Address - Country:US
Mailing Address - Phone:210-587-6177
Mailing Address - Fax:210-587-6179
Practice Address - Street 1:15321 SAN PEDRO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3700
Practice Address - Country:US
Practice Address - Phone:210-587-6177
Practice Address - Fax:210-587-6179
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18735103TC0700X
TX34186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical