Provider Demographics
NPI:1154759264
Name:RUIZ, STEPHANIE MONIQUE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MONIQUE
Last Name:RUIZ
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 1:160 E VIRGINIA ST
Mailing Address - Street 2:SUITE #280
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:SUITE #280
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-296-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CAR1240901016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)