Provider Demographics
NPI:1417414921
Name:RUIZ, VANESSA MICHEL
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MICHEL
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 1:167 LAMBERT ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0836
Mailing Address - Country:US
Mailing Address - Phone:805-827-0642
Mailing Address - Fax:
Practice Address - Street 1:2200 OUTLET CENTER DR UNIT 430
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0611
Practice Address - Country:US
Practice Address - Phone:805-827-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA105135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health