Provider Demographics
NPI:1831928142
Name:RUVALCABA, ANGELICA VIVIANA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:VIVIANA
Last Name:RUVALCABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIV
Other - Middle Name:
Other - Last Name:RUVALCABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1604 CAT LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-1581
Mailing Address - Country:US
Mailing Address - Phone:805-868-7336
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4558
Practice Address - Country:US
Practice Address - Phone:805-781-4753
Practice Address - Fax:805-781-1227
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)