Provider Demographics
NPI:1184451825
Name:DIRCIO-GASPAR, RUBY CAZANDRA
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:CAZANDRA
Last Name:DIRCIO-GASPAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 N AIRPORT RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-9472
Mailing Address - Country:US
Mailing Address - Phone:509-669-8359
Mailing Address - Fax:
Practice Address - Street 1:401 E MOUNTAIN VIEW AVE STE 4
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3795
Practice Address - Country:US
Practice Address - Phone:509-852-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician