Healthcare Provider Details

I. General information

NPI: 1396665139
Provider Name (Legal Business Name): GIL RUELOS CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 HOLLENBECK AVE
SUNNYVALE CA
94087-5402
US

IV. Provider business mailing address

812 LORI AVE
SUNNYVALE CA
94086-4829
US

V. Phone/Fax

Practice location:
  • Phone: 408-734-6014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number99456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: