Provider Demographics
NPI:1851757918
Name:WUNDERLEY, RUTH LEANNE BARIONI (CTRS)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:LEANNE BARIONI
Last Name:WUNDERLEY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:LEANNE
Other - Last Name:BARIONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:21732 S VERMONT AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2180
Mailing Address - Country:US
Mailing Address - Phone:213-269-0622
Mailing Address - Fax:
Practice Address - Street 1:21732 S VERMONT AVE STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2180
Practice Address - Country:US
Practice Address - Phone:310-781-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53183172V00000X, 225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No172V00000XOther Service ProvidersCommunity Health Worker