Healthcare Provider Details

I. General information

NPI: 1649906066
Provider Name (Legal Business Name): GLADYS YVONNE RULLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3286 E GUASTI RD STE 100
ONTARIO CA
91761-8646
US

IV. Provider business mailing address

333 E ARROW HWY UNIT 220
UPLAND CA
91785-7008
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: