Individual provider Active NPI

Ivan Ruiz, PHD

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1346056884
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY35734 Issued in CA
Practice address
740 Westwood PLZ Ste C8-222
Los Angeles, CA 90095-8353
Phone
(310) 206-9326
NPI assigned
Dec 9, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY35734 CA
Clinical Psychologist 103TC0700X PSY35734 CA Primary

Addresses

Primary practice location

740 Westwood PLZ Ste C8-222
Los Angeles, CA 90095-8353

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone (310) 454-5043

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
I20251009002129 CA Practitioner - Clinical Psychologist 1658878103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5767 W Century Blvd
Suite 400
Los Angeles, CA 90045-5631

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY35734CAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Clinical CurrentSince Nov 1, 2025 Accepting new patients

Locations

300 Medical Plz
Los Angeles, CA 90095
Phone (310) 206-8438

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

Organizations & group practices 1

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": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1346056884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 WESTWOOD PLZ STE C8-222",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958353",
            "telephone_number": "310-206-9326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12021 Wilmington Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900593019",
            "country_code": "US",
            "telephone_number": "310-454-5043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUIZ",
        "first_name": "IVAN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY35734",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY35734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.