Provider Demographics
NPI:1619093200
Name:MARRUJO, RON GILBERT (MFT)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:GILBERT
Last Name:MARRUJO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MANCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3530
Mailing Address - Country:US
Mailing Address - Phone:775-426-8219
Mailing Address - Fax:775-423-4054
Practice Address - Street 1:165 N CARSON ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2919
Practice Address - Country:US
Practice Address - Phone:775-426-8219
Practice Address - Fax:775-423-4054
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist