Provider Demographics
NPI:1457725954
Name:GOVEA, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GOVEA
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 1:630 S GLASSELL ST
Mailing Address - Street 2:#104B
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 S GLASSELL ST
Practice Address - Street 2:#104B
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3004
Practice Address - Country:US
Practice Address - Phone:714-944-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist