Provider Demographics
NPI:1689889743
Name:RUNCIMAN, MARIA ASCENSION (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ASCENSION
Last Name:RUNCIMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:CORRALITOS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0364
Mailing Address - Country:US
Mailing Address - Phone:831-728-2494
Mailing Address - Fax:831-393-3115
Practice Address - Street 1:5905 SOQUEL DR STE 650
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2862
Practice Address - Country:US
Practice Address - Phone:831-728-2494
Practice Address - Fax:831-393-3115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12215569OtherCAQH UNIVERSAL PROVIDER DATASOURCE