Healthcare Provider Details

I. General information

NPI: 1013860741
Provider Name (Legal Business Name): GUSTAVO ANGEL RUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E MARKET ST
SALINAS CA
93905-2831
US

IV. Provider business mailing address

1061 PALM AVE
SOLEDAD CA
93960-2722
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5700
  • Fax:
Mailing address:
  • Phone: 831-753-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number250191514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: