Provider Demographics
NPI:1447439815
Name:RUIZ, CONTESSA MONIQUE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CONTESSA
Middle Name:MONIQUE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2660
Mailing Address - Country:US
Mailing Address - Phone:626-765-7452
Mailing Address - Fax:
Practice Address - Street 1:150 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2660
Practice Address - Country:US
Practice Address - Phone:626-765-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54642106H00000X
CAMFC50228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist