Provider Demographics
NPI:1386081180
Name:RUIZ, ANDREA RACHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RACHELLE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RACHELLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:167 SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3575
Mailing Address - Country:US
Mailing Address - Phone:916-201-5510
Mailing Address - Fax:
Practice Address - Street 1:5030 BUSINESS CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6909
Practice Address - Country:US
Practice Address - Phone:916-201-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist