Healthcare Provider Details

I. General information

NPI: 1467767715
Provider Name (Legal Business Name): MARIA RUELAS-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 ELVIS DR
SAN JOSE CA
95123-4831
US

IV. Provider business mailing address

542 ELVIS DR
SAN JOSE CA
95123-4831
US

V. Phone/Fax

Practice location:
  • Phone: 408-799-3645
  • Fax: 408-226-4776
Mailing address:
  • Phone: 408-799-3645
  • Fax: 408-226-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: