Healthcare Provider Details

I. General information

NPI: 1629453808
Provider Name (Legal Business Name): ROUEL ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 JAMACHA ROAD SUITE 107
EL CAJON CA
92019-3225
US

IV. Provider business mailing address

860 JAMACHA ROAD SUITE 107
EL CAJON CA
92019-3225
US

V. Phone/Fax

Practice location:
  • Phone: 619-456-9920
  • Fax: 619-456-9340
Mailing address:
  • Phone: 619-456-9920
  • Fax: 619-456-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA ROUEL
Title or Position: MD
Credential:
Phone: 619-456-9920