Provider Demographics
NPI:1962751891
Name:CARRASCO, RUTH C
Entity type:Individual
Prefix:MISS
First Name:RUTH
Middle Name:C
Last Name:CARRASCO
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 1:600 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5770
Mailing Address - Country:US
Mailing Address - Phone:323-750-9247
Mailing Address - Fax:323-750-9248
Practice Address - Street 1:600 W MANCHESTER AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5770
Practice Address - Country:US
Practice Address - Phone:323-750-9247
Practice Address - Fax:323-750-9248
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12060101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)