Healthcare Provider Details

I. General information

NPI: 1952731556
Provider Name (Legal Business Name): RANDI LYNN RUELA DC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. RANDI LYNN HIGINBOTHAM

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIMPAU AVE STE 106
CORONA CA
92879-5724
US

IV. Provider business mailing address

710 RIMPAU AVE STE 106
CORONA CA
92879-5724
US

V. Phone/Fax

Practice location:
  • Phone: 951-428-4135
  • Fax:
Mailing address:
  • Phone: 951-428-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32763
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32763
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: