Provider Demographics
NPI:1063596476
Name:RUARK, DANIEL (MFT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RUARK
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 1:9854 NATIONAL BLVD # 372
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2713
Mailing Address - Country:US
Mailing Address - Phone:323-655-5880
Mailing Address - Fax:
Practice Address - Street 1:3020 CASTLE HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2753
Practice Address - Country:US
Practice Address - Phone:323-655-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist