Provider Demographics
NPI:1891823613
Name:OVANDO, RUBEN (MFT)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:OVANDO
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 1:3719 E 1ST ST
Mailing Address - Street 2:APT. B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2777
Mailing Address - Country:US
Mailing Address - Phone:310-422-3106
Mailing Address - Fax:
Practice Address - Street 1:3719 E 1ST ST
Practice Address - Street 2:APT. B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-2777
Practice Address - Country:US
Practice Address - Phone:310-422-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist