Provider Demographics
NPI:1255048112
Name:TOBOR-VASQUEZ, RUBY (RAC)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:TOBOR-VASQUEZ
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 EDWARD LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4148
Mailing Address - Country:US
Mailing Address - Phone:925-961-2693
Mailing Address - Fax:
Practice Address - Street 1:1915 D ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2571
Practice Address - Country:US
Practice Address - Phone:925-754-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-RBJPWG175T00000X
CA15413-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist