Provider Demographics
NPI:1376001297
Name:CHAVEZ MALDONADO, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:CHAVEZ MALDONADO
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 1:1604 ALMADOR TER
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4202
Mailing Address - Country:US
Mailing Address - Phone:209-489-7408
Mailing Address - Fax:
Practice Address - Street 1:1343 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4438
Practice Address - Country:US
Practice Address - Phone:209-725-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)