Provider Demographics
NPI:1104120377
Name:RUIZ-LICHTER, REBECCA LUISA
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LUISA
Last Name:RUIZ-LICHTER
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 1:1407 2ND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1744
Mailing Address - Country:US
Mailing Address - Phone:415-902-2794
Mailing Address - Fax:
Practice Address - Street 1:440 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1430
Practice Address - Country:US
Practice Address - Phone:415-487-6740
Practice Address - Fax:415-487-6724
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)