Individual provider Active NPI

Brandon Ruvalcaba, LCSW

  • Clinical Social Worker
  • Covina, CA
National Provider Identifier
1659757805
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
110770 Issued in CA
Practice address
1359 N Grand Ave
Covina, CA 91724-1016
Phone
(626) 430-2853
Fax
(626) 331-0035
NPI assigned
Aug 10, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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 ASW91651 CA
Clinical Social Worker 1041C0700X 110770 CA Primary

Addresses

Primary practice location

1359 N Grand Ave
Covina, CA 91724-1016

Mailing address

1359 N Grand Ave
Covina, CA 91724-1016
Phone (626) 430-2853

Other identifiers 3

IdentifierTypeStateIssuer
6758MedicaidCA
7420MedicaidCA
7068MedicaidCA

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
I20250410001848 CA Practitioner - Clinical Social Worker 4385168491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Los Angeles County Department of Mental HealthGroup PAC ID 7416869896, 294 clinicians

Practice addresses (Care Compare)

1359 N Grand Ave
FL 1
Covina, CA 91724-1016
Phone (626) 430-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW91651CAMDMental Health Counselor
110770CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jan 31, 2025 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jan 31, 2025 Accepting new patients

Locations

330 E Live Oak Ave
Arcadia, CA 91006
Phone (626) 254-1400

1359 N Grand Ave
Covina, CA 91724
Phone (626) 430-2900

1359 N Grand Ave
Fl 1
Covina, CA 91724
Phone (626) 430-2900

349A E Avenue K6
Lancaster, CA 93535
Phone (661) 723-4260

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 3

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": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1659757805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2853",
            "fax_number": "626-331-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2853",
            "fax_number": "626-331-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUVALCABA",
        "first_name": "BRANDON",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-10",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW91651",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "110770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6758",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.