Individual provider Active NPI

Melissa Renae Ruvalcaba

  • Clinical Social Worker
  • Fullerton, CA
National Provider Identifier
1073009478
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
801 E. Champman Ave
# 203
Fullerton, CA 92831-3839
Phone
(714) 680-9000
Fax
(714) 680-8233
NPI assigned
Jul 9, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW83519 CA
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

801 E. Champman Ave
# 203
Fullerton, CA 92831-3839

Mailing address

PO Box 919
Fullerton, CA 92836-0919
Phone (714) 680-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240610001950 CA Practitioner - Clinical Social Worker 6800338583 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW83519CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Center for New Directions, Inc. Mental Health CurrentSince Apr 10, 2024 Accepting new patients
Crittenton Services Past Accepting new patients
Stephen M Pumphrey Licensed Clinical Social Workers Inc Clinical PastSince Dec 25, 2018 Accepting new patients

Locations

1101 California Ave
Ste 204
Corona, CA 92881
Phone (951) 523-0221

23201 Mill Creek Dr
Ste 220
Laguna Hills, CA 92653
Phone (949) 460-5320

1100 Melody Ln
Ste 108
Roseville, CA 95678

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1073009478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928360919",
            "telephone_number": "714-680-9000",
            "fax_number": "714-680-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E. CHAMPMAN AVE",
            "address_2": "# 203",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928313839",
            "telephone_number": "714-680-9000",
            "fax_number": "714-680-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUVALCABA",
        "first_name": "MELISSA",
        "middle_name": "RENAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW83519",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.