Basic Information
| Provider Information | |||||||||
| NPI: | 1235569815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUVALCABA | ||||||||
| FirstName: | EDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7922 STEWART AND GRAY RD APT 1 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232702640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2677 1/2 ZOE AVE. | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233120640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.