1063643666 NPI number — MRS. JILL L RUBY-WAHBA MA, MFT, ATR

Table of content: MRS. JILL L RUBY-WAHBA MA, MFT, ATR (NPI 1063643666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063643666 NPI number — MRS. JILL L RUBY-WAHBA MA, MFT, ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBY-WAHBA
Provider First Name:
JILL
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, MFT, ATR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063643666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 AVENUE H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-5101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
130-720-1784
Provider Business Mailing Address Fax Number:
310-540-6590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 SKYPARK DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-254-9393
Provider Business Practice Location Address Fax Number:
424-634-7688
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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