MEDICARE: ERICK SANTIAGO RUELAS ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	111186	CA

General Provider Information

NPI Number	:	1134899222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK SANTIAGO RUELAS ACSW

Provider Business Mailing Address
First Line	:	3055 W ORANGE AVE STE 105
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 W ORANGE AVE STE 105
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3152
Country	:	US
Telephone Number	:	714-638-8277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	01/28/2026

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