Healthcare Provider Details

I. General information

NPI: 1043947880
Provider Name (Legal Business Name): JOANNA A RUELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 NATIVIDAD RD
SALINAS CA
93906-3138
US

IV. Provider business mailing address

55 PLAZA CIR
SALINAS CA
93901-2952
US

V. Phone/Fax

Practice location:
  • Phone: 831-754-4444
  • Fax:
Mailing address:
  • Phone: 831-757-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: