MEDICARE: ANTONELLA AGUILERA-RUIZ ND

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	175F00000X	Naturopath	ND-526	CA

General Provider Information

NPI Number	:	1245673953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONELLA AGUILERA-RUIZ ND

Provider Business Mailing Address
First Line	:	4408 SHORTHORN RD
Second Line	:
City	:	RESCUE
State	:	CA
Zip	:	95672-9413
Country	:	US
Telephone Number	:	530-748-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 SMITH FLAT RD STE A
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5049
Country	:	US
Telephone Number	:	530-350-6710
Fax Number	:

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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