Active NPI
Sergio Ruiz, MS, MDFT, PCI
- Professional Counselor
- San Rafael, CA
National Provider Identifier
1073954277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPCC4629
- Practice address
- 3230 Kerner Blvd
San Rafael, CA 94901-4840 - Phone
- (415) 299-3646
- NPI assigned
- Jul 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPCC4629 | CA | Primary |
Addresses
Primary practice location
3230 Kerner Blvd
San Rafael, CA 94901-4840
Mailing address
3230 Kerner Blvd
San Rafael, CA 94901-4840
Phone (415) 299-3646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPCC4629 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763596800000",
"number": "1073954277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3230 KERNER BLVD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949014840",
"telephone_number": "415-299-3646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3230 KERNER BLVD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949014840",
"telephone_number": "415-299-3646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUIZ",
"first_name": "SERGIO",
"credential": "MS, MDFT, PCI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-16",
"last_updated": "2025-11-20",
"certification_date": "2025-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "LPCC4629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.