Provider Demographics
NPI:1629429022
Name:RUIZ, ELAINE ZAVALA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:ZAVALA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 RIDEOUT WAY
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2214
Mailing Address - Country:US
Mailing Address - Phone:562-463-2817
Mailing Address - Fax:
Practice Address - Street 1:1157 LEMOYNE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3206
Practice Address - Country:US
Practice Address - Phone:213-483-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 294131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical