Healthcare Provider Details

I. General information

NPI: 1710467113
Provider Name (Legal Business Name): PABLO ABRAHAN RUANO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 W STETSON AVE STE 100
HEMET CA
92545-9682
US

IV. Provider business mailing address

1901 W LUGONIA AVE STE 120
REDLANDS CA
92374-9704
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-1600
  • Fax:
Mailing address:
  • Phone: 909-557-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: