Provider Demographics
NPI:1841957800
Name:RUZIC, SOPHIE SARAH (PSYD)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:SARAH
Last Name:RUZIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:SCHMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:954 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3782
Mailing Address - Country:US
Mailing Address - Phone:909-946-4222
Mailing Address - Fax:909-946-8243
Practice Address - Street 1:954 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3782
Practice Address - Country:US
Practice Address - Phone:909-946-4222
Practice Address - Fax:909-946-8243
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2024-09-16
Deactivation Date:2022-02-08
Deactivation Code:
Reactivation Date:2022-12-05
Provider Licenses
StateLicense IDTaxonomies
CAPSY33815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical