Healthcare Provider Details

I. General information

NPI: 1770715815
Provider Name (Legal Business Name): FELICITAS RUELAS NUNEZ III R.N., P.H.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD
SAN DIEGO CA
92120-3410
US

IV. Provider business mailing address

6160 MISSION GORGE RD
SAN DIEGO CA
92120-3410
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-4000
  • Fax:
Mailing address:
  • Phone: 619-528-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number574540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: