Provider Demographics
NPI:1891172672
Name:RUFFONI, DINO JR
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:
Last Name:RUFFONI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:RUFFONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:3530 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1529
Mailing Address - Country:US
Mailing Address - Phone:707-535-6895
Mailing Address - Fax:
Practice Address - Street 1:100 E ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4608
Practice Address - Country:US
Practice Address - Phone:707-535-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #48200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist