Provider Demographics
NPI:1508404260
Name:AKOWUAH, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:AKOWUAH
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 1:116 AGNES AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2838
Mailing Address - Country:US
Mailing Address - Phone:805-457-3724
Mailing Address - Fax:
Practice Address - Street 1:116 AGNES AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-2838
Practice Address - Country:US
Practice Address - Phone:805-457-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205480563Medicaid