MEDICARE: JOSEPH DIEGO RUEDA PA-S

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	363A00000X	Physician Assistant	PA19533	TX

General Provider Information

NPI Number	:	1174306179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH DIEGO RUEDA PA-S

Provider Business Mailing Address
First Line	:	3533 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3604
Country	:	US
Telephone Number	:	817-419-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3604
Country	:	US
Telephone Number	:	817-419-0303
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	04/14/2026

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