Provider Demographics
NPI:1326562448
Name:SELF, SILVIA CAROLINA
Entity Type:Individual
Prefix:MRS
First Name:SILVIA
Middle Name:CAROLINA
Last Name:SELF
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SILVIA
Other - Middle Name:CAROLINA
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 E AVENUE Q5 APT 11
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2900
Mailing Address - Country:US
Mailing Address - Phone:661-365-9884
Mailing Address - Fax:
Practice Address - Street 1:1025 E AVENUE Q5 APT 11
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2900
Practice Address - Country:US
Practice Address - Phone:661-365-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R1245300317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1245300317OtherSUBSTANCE ABUSE COUNSELING
R1245300317OtherSUBSTANCE ABUSE COUNSELING