Ruby Banuelos Calhoun, LCSW
Individual provider Active NPI Clinical Social Worker · Diamond Bar, CA
NPI 1902379985 · NPPES record last updated Sep 20, 2023
Key facts
- NPI
- 1902379985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 75258 (CA)
- Practice address
- 253 S Diamond Bar Blvd
Diamond Bar, CA 91765-1606 - Phone
- (909) 396-7025
- NPI assigned
- Jan 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231003003280 | CA | Practitioner - Clinical Social Worker | 8022355783 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75258 | CA | MD | Pharmacist |
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Current | Accepting new patients |
Locations
200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841
253 S Diamond Bar Blvd
Diamond Bar, CA 91765
Phone (909) 860-1144
1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144
100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 75258 | CA | Yes |
Addresses
Primary practice location
253 S Diamond Bar Blvd
Diamond Bar, CA 91765-1606
Mailing address
253 S Diamond Bar Blvd
Diamond Bar, CA 91765-1606
Phone (909) 396-7025
Other names
- Ruby Banuelos
Other providers in Diamond Bar, CA
- Claudia Baettig
- Sushma Bahl
- Randy Balbuena
- Carey Balderrama
- Thomas Strand Ball
- Douglas L Barcon
- Lizbeth Barragan
- Danni Barton
- Nermine Samir Batniji
- Raaed Samir Batniji
All providers in Diamond Bar, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.