Provider Demographics
NPI:1548420805
Name:LESTER, RUTH E
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:LESTER
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:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-2925
Mailing Address - Country:US
Mailing Address - Phone:909-337-0434
Mailing Address - Fax:909-336-3023
Practice Address - Street 1:27307 STATE HIGHWAY 189
Practice Address - Street 2:SUITE 207
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317
Practice Address - Country:US
Practice Address - Phone:909-337-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist