Provider Demographics
NPI:1669170213
Name:RUBEN, ELISA (LMFT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:RUBEN
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 1:3005 CORBINA ALY BLDG 263
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-5110
Mailing Address - Country:US
Mailing Address - Phone:619-536-3120
Mailing Address - Fax:
Practice Address - Street 1:3005 CORBINA ALY BLDG 263
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5110
Practice Address - Country:US
Practice Address - Phone:619-536-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist